Suitable timing of surgical intervention for ruptured ovarian endometrioma

Huang, Yu-Hsin; Hsieh, Chu‐Chin; Shiau, Chii-Shinn; Lo, Lun Jou; Liou, Jui-Der; Chang, Ming‐Yang

doi:10.1016/j.tjog.2014.04.018

Cited by 13 publications

(11 citation statements)

References 18 publications

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“…This complication can develop spontaneously, there are cases reported during menstruation [ 24 ] and periovulatory stages [ 25 ], but it more often occurs during pregnancy, after abdominal and pelvic trauma [ 26 ]. Also, the risk is higher when the diameter of endometrioma is ≥6cm [ 27 ]. Takami et al [ 26 ] reported a 2.8% incidence of the rupture of ovarian endometrioma during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Acute Diffuse Peritonitis Due to Spontaneous Rupture of an Infected Endometrioma: A Case Report

Petruškevičiūtė

Bužinskienė

2021

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Background. Endometriosis is defined as a chronic, inflammatory, estrogen-dependent gynaecologic disease. It affects approximately 5–10% of reproductive-age women worldwide. Ovarian endometriosis is the most frequent form of this condition. Endometriotic cysts are found in about 17–44% of women diagnosed with endometriosis. It is well known, that ovarian endometriomas can cause infertility and chronic pelvic pain. Enlarging cysts can also cause ovarian torsion. In addition, ovarian endometriosis slightly increases the risk for ovarian cancer. The rupture of endometriotic ovarian cysts is an exceptional complication. According to the literature, the prevalence is less than 3% among women with endometriosis. The rupture of an ovarian endometrioma can cause acute peritonitis, which can lead to sepsis, septic shock and can be lethal. The occurrence of abscesses within an ovarian endometrioma is an extremely rare complication. Generally, the origin of infected endometriotic ovarian cysts is related to the previous invasive procedures involving pelvic organs or the use of intrauterine devices. Also, ovarian abscesses can be caused by the hematogenous or lymphatic spread of bacteria. Although, the literature points out that infection of endometriotic ovarian cysts can develop spontaneously. In these rare cases, reservoir and route of infection remains an enigma.Case report. A 49-year-old female was brought to the emergency room with severe generalized lower abdominal pain (6/10) and three days lasting fever. Abdominal examination revealed diffuse abdominal pain with anterior abdominal wall muscle tension. Painful solid masses were felt on both sides of the uterus during the pelvic examination. Cystic masses were detected in both ovaries during transvaginal sonography. Computer tomography (CT) of the abdomen and pelvis revealed abnormal changes in both ovaries. A small amount of free fluid was found in the pelvic cavity along with thickened pelvic peritoneum. Suspecting acute peritonitis and bilateral tubo-ovarian abscesses, surgical treatment was performed. Lower midline laparotomy with bilateral adnexectomy and abdominal lavage with 4000 ml normal saline were done. The outcome of peritonitis was evaluated using the Mannheim peritonitis index (MPI=17 – low risk of morbidity and mortality). The histopathological examination revealed the diagnosis of bilateral endometriotic cysts complicated with acute inflammation, with associated acute inflammation of both fallopian tubes. Microbiological cultures from the purulent fluid were negative.Conclusions. Although the occurrence of abscesses within an ovarian endometrioma is an extremely rare finding in clinical practice, it has to be considered by gynaecologists because it might result in a surgical emergency that can be life-threatening. Being aware of the risk factors of abscesses within an endometrioma can lead to an early diagnosis of this rare condition and help to avoid serious complications.

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Section: Discussionmentioning

confidence: 99%

Acute Diffuse Peritonitis Due to Spontaneous Rupture of an Infected Endometrioma: A Case Report

Petruškevičiūtė

Bužinskienė

2021

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“…To our knowledge, there were no previous reports comparing the frequency of rupture of the ovarian cyst between its types. However, adhesion is more likely in endometrial cysts than other types of ovarian cyst , and decidualization during pregnancy can affect endometrial cysts resulting in softening to be more likely to rupture . Thus, endometrial cyst has the risk of rupture during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Labor may mask a symptom of the rupture of ovarian endometrial cyst: a case report

Kino

Obata

Osanai

et al. 2018

Clinical Case Reports

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“…The rupture of an endometrioma is a rare event, with an estimated incidence of less than 3% among women of childbearing age who are known to have endometriomas ( 5 ) . This situation occurs more commonly during pregnancy, due to hormonal stimulation of endometrial stromal elements ( 2 ) , albeit with larger (≥ 6.0 cm) lesions ( 6 ) .…”

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confidence: 99%

“…The importance of the preoperative diagnosis is to support treatment strategies. Although some milder cases can be managed conservatively, there is a tendency toward greater use of early surgical exploration because of long-term undesirable effects of cyst fluid in the peritoneal cavity, such as adhesions, pelvic pain, and infertility ( 6 ) . In addition, the presumptive diagnosis of ruptured endometrioma, rather than ovarian neoplasms, facilitates the decision to perform laparoscopic exploration and allows the surgeon to perform the procedure with greater confidence.…”

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confidence: 99%

Ruptured endometrioma: main imaging findings

et al. 2018

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Suitable timing of surgical intervention for ruptured ovarian endometrioma

Abstract: Comprehensive and early surgical intervention after endometrioma rupture can assist in excluding ovarian malignancy and can reduce the effects of cyst fluids, prevent adhesions, and preserve fertility.

Cited by 13 publications

References 18 publications

Acute Diffuse Peritonitis Due to Spontaneous Rupture of an Infected Endometrioma: A Case Report

Acute Diffuse Peritonitis Due to Spontaneous Rupture of an Infected Endometrioma: A Case Report

Labor may mask a symptom of the rupture of ovarian endometrial cyst: a case report

Ruptured endometrioma: main imaging findings

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