Ovarian Cyst

These cysts are common and generally cause no trouble. Each time a woman ovulates, she forms a small ovarian cyst (3.0 cm in diameter or less). Depending on where she is in her menstrual cycle, you may find a small ovarian cyst. Large cysts (>7.0 cm) are less common and should be followed clinically or with ultrasound.

Occasionally, ovarian cysts may cause a problem by:

Delaying menstruation
Rupturing
Twisting
Causing pain
Bleeding

95% of ovarian cysts disappear spontaneously, usually after the next menstrual flow. Those that remain and those causing problems are often removed surgically.

Ruptured Ovarian Cyst

This cyst has ruptured and spilled its contents into the abdominal cavity. If the cyst is small, its rupture usually occurs unnoticed. If large, or if there is associated bleeding from the torn edges of the cyst, then the cyst rupture can be accompanied by pain. The pain is initially one-sided and then spreads to the entire pelvis. If there is a large enough spill of fluid or blood, the patient will complain of right shoulder pain.

Symptoms should resolve with rest alone. Rarely, surgery is necessary to stop continuing bleeding.

Unruptured Ovarian Cyst

While most of these cysts are without symptoms, they can cause pain, particularly with strenuous physical activity or intercourse. Treatment is symptomatic with rest for those with significant pain. The cyst is expected to rupture, usually within one month. Once it ruptures, symptoms will gradually subside and no further treatment is necessary.

If it doesn’t rupture spontaneously, surgery is sometimes performed to remove it. This will relieve the symptoms and prevent torsion. This surgery is done electively.

Torsioned Ovarian Cyst

A torsioned or twisted ovarian cyst occurs when the cyst twists on its vascular stalk, disrupting its blood supply. The cyst and ovary necrotise.

Patients with this problem complain of severe unilateral pain with signs of peritonitis. This problem is often indistinguishable clinically from a pelvic abscess or appendicitis, although an ultrasound scan can be helpful.

Treatment is surgery to remove the necrotic adnexa. If surgery is unavailable, then bedrest, IV fluids and pain medication may result in a satisfactory, though prolonged, recovery. In this suboptimal, non-surgical setting, metabolic acidosis resulting from the tissue necrosis may be the most serious threat to the patient.

Other surgical conditions which may resemble a twisted ovarian cyst (such as bowel obstruction, appendicitis, ectopic pregnancy) may not have a good outcome if surgery is delayed. For this reason, patients thought to have a torsioned ovarian cyst should be moved to a definitive care setting where surgery is available.

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