A Case of Giant Ovarian Cyst Managed Successfully Through Laparoscopic Surgery

Abstract

Mucinous ovarian tumors account for 15% all ovarian neoplasms, of which giant variants rarely occur. Recently huge ovarian cysts (more than 12 kg) are now rarely seen because of the development in health care systems and education. The patient is 26-yearold nulligravida female who presented with abdominal distension. A laparoscopic left salpingo-oophorectomy was performed. Laparoscopic approach to giant ovarian cyst may be difficult regarding the risk of cyst rupture and limited working space. To reduce the limitations of the laparoscopy, we performed laparoscopy after aspirating the cystic contents. During laparoscopy, abdominal cavity was explored by the scope. Cyst contained about 53 L of fluid. The histopathologic examination revealed a borderline mucinous tumor of the left ovary. Laparoscopic excision of giant ovarian cyst seems to be safe and applicable treatment modality. Copyright © 2012. Korean Society of Obstetrics and GynecologyLaparoscopic approach is more advantageous over laparotomy, considering better cosmetic results, lesser blood loss, lesser pain and analgesic requirement, faster recovery, and shorter hospitalization time [1]. Laparoscopic approach to giant ovarian cyst, in cases when the cysts' sizes exceed to the umbilicus, may be difficult regarding the risk of cyst rupture and limited working space [2]. However, if the laparotomy is chosen as the operative treatment, a larger incision is required to excise the cyst. We present a case of laparoscopic extirpation of a giant ovarian cyst. Case ReportA 26-year-old woman was referred to our department for a giant abdominal mass in July 2011. She was single and nulliparous female who presented with a gradually increasing abdominal swelling first noticed 4 years ago. Due to the huge mass she was unable to walk and had anorexia and weight gain. At admission, the emaciated patient weighted 120 kg, had a body height of 177 cm and abdominal girth at the level of the umbilicus was 190 cm (Fig. 1). There was no history of colicky pain fainting attacks, vomiting or other gastrointestinal attacks. She had no previous history of any illnesses, allergies or operations. On abdominal examination, abdomen was grossly distended engorged veins present, fluid thrill was present. There were no abnormalities in hematologic and biochemical data including cancer biomarkers CA-125, CA 19-9, and carcinoembryonic antigen. On ultrasonography, a huge, multilocular cystic tumor with low echogenic content was found (Fig. 2). There were no papillary or solid parts of associated with the wall or septa, and no ascites. She could not fit into the computed tomography machine due to the giant abdominal mass. After consultation with the anesthesiology and cardiology teams, the patient was placed in a semiFowler's position in the operating room due to dyspnea, general anesthesia and endotracheal tube intubation was performed. After CASE REPORT Korean J Obstet Gynecol 2012;55(7):534-537 http://dx

Laparoscopic management of giant ovarian cyst in young woman: a case report

“…Due to better imaging modalities giant ovarian cyst is a rare finding as diagnosis is made at an early stage. 5 Site of origin of giant intra-abdominal cyst can be ovaries, gastrointestinal region, urological and lymphatics. 6 In 1922 Spohn documented and removed largest ovarian tumour weighing approximately148.6 kg and Symonds in 1963 reported an ovarian cyst of 72 kg.…”

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“…4 Because of the risk of cyst rupture and small working space, laparoscopic approach to larger ovarian cysts extending up to umbilicus may be difficult. 5 Herein we report a case of a young female with history of increasing abdominal girth over a period of 2 year along with radiological findings suggestive of very large tumour arising from the right ovary and treated by complete laparoscopic removal of the giant ovarian cyst.…”

Laparoscopic ovarian cystecomy for a huge ovarian cystic mass : A case report and review of literature

“…The literature, to our knowledge, did not define a maximum size of a cyst to be as contraindication for laparoscopic intervention as it is mainly dependent on the experience of the operator. Conservative surgery is always preferred in young females at reproductive age group [21,22] .…”

Twenty Weeks Pregnancy with Giant Cyst: Anesthesia Problem and Perioperative Preparation

“…Kim et al found that only 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. 14 Laparoscopic approach allows proper exposure of Cul de sac and allow forceful jet lavage aspiration ensuring pelvic clean out from any microscopic material of the dermoid cyst. A situation may not be available during open laparotomy.…”