Ovarian Cyst/torsion

Description

• Ovarian cysts:
  • Generally asymptomatic until complicated by hemorrhage, torsion, rupture, or infection
  • Follicular cysts:
    • Most common
    • Occur from fetal life to menopause
    • Unilocular; diameter 3–8 cm
    • Thin wall predisposes to rupture, which usually causes minimal or no bleeding
    • Rupture during ovulation at midcycle is known as mittelschmerz
  • Corpus luteal cysts:
    • Most significant
    • Diameter 3 cm, but usually <10 cm
    • Rapid bleeding from intracystic hemorrhage causes rupture
    • Rupture is most common just before menses due to increased vascularity
    • Can cause severe intraperitoneal bleeding
    • Gradual bleeding into cyst or ovary distends capsule and may cause pain without rupture
• Adnexal torsion:
  • Fifth most prevalent surgical gynecologic emergency
  • Twisting of vascular pedicle of ovary, fallopian tube, or paratubal cyst
  • Causes adnexal ischemia leading to necrosis
  • Can lead to infertility
  • Occlusion of lymphatics and venous drainage leads to rapid enlargement of adnexa
  • Greatest risk with cysts 8–12 cm

Risk Factors

• Reproductive-age women
• Ovarian cysts, especially >5 cm
• Ovarian hyperstimulation
• Tumors: Serous cystadenoma most common; teratomas (benign cysts > malignancy)
• Pelvic surgery: Tubal ligation; hysterectomy
• Pregnancy
• History of pelvic inflammatory disease

• Anticoagulated patients at increased risk of:
  • Hemorrhagic corpus luteal cyst
  • Significant bleed from ruptured cyst

Etiology

• Ovarian cyst:
  • Follicular cysts result from nonrupture of mature follicle or failure of atresia of immature follicle
  • Corpus luteal cysts result from unrestrained growth in early pregnancy or from normal intracystic hemorrhage days after ovulation
  • Other cysts:
    • Theca lutein
    • Cystic teratoma
    • Endometrioma (chocolate cyst)
• Adnexal torsion:
  • Right > left
  • Highest frequency in reproductive women