Benign Gynaecology: Varian YST Ccidents
Benign Gynaecology: Varian YST Ccidents
Benign Gynaecology: Varian YST Ccidents
BENIGN GYNAECOLOGY
Ovarian cyst accidents refer to any of the three complications of ovarian cysts .
1. Ovarian torsion
2. Ovarian cyst haemorrhage
3. Ovarian cyst rupture
KEY POINTS:
Other gynaecological complications can present similarly to an ovarian cyst event. Consider on
examination conditions such as: ectopic pregnancy, pelvic inflammatory disease, tubo-ovarian
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abscess, or non gynaecological issues e.g. appendicitis .
Ovarian cyst accidents will most commonly involve benign ovarian cysts.
TORSION
Ovarian torsion, or adnexal torsion; is partial or complete rotation of the ovarian vascular pedicle
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causing obstruction to venous outflow and later arterial inflow . The incidence of ovarian torsion occurs
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mainly in women of childbearing age, it is rare and accounts for 3% of gynaecologic emergencies .
Thought to be primarily caused by a heavy ovary in conditions such as ovarian hyper stimulation or
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teratoma; right sided ovarian torsion is more common . 10-20% of ovarian torsion can occur during
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pregnancy; with infertility treatment being a possible risk factor . Reoccurrence can occur in polycystic
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ovaries . 15% of ovarian torsion can occur in children and adolescents .
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DPMS
Ref: 8432
Characterised by colicky pain in lower abdomen or pelvic tenderness which becomes constant
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and can disappear if tissue is severely necrosed .
The presence of an adnexal mass on USS raises the suspicion of a torted ovarian cyst.
Doppler sonography can be useful in diagnosis but normal blood flow does not exclude
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torsion .
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
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During surgery de-torsion only is recommended as blood resupply in 91-100% of cases will be
restored. Further surgery at a later stage should be considered for cysts deemed to be
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complex .
Characterised by a sudden onset of sharp then constant ache. Pain is at its worst at the time of
onset.
Most women are systemically well; mild signs of peritonism may be present on examination,
not associated with fevers, tachycardia or inflammatory markers.
If significant blood loss occurs the women could present with hypovolemic shock. This is a very
late sign.
MANAGEMENT
Address any predisposing cause such as Factor VIII deficiency causing haemorrhage .
If the pain persists beyond a few days then laparoscopy should be considered.
All guidelines should be read in conjunction with the Disclaimer at the beginning of this section
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REFERENCES ( STANDARDS)
1.
Bottomley. C., Bourne. T. Diagnosis and management of ovarian cyst accidents Best Practice & Research
Clinical Obstetrics & Gynaecology. 2009;23:711-24.
2.
Ramphal. S.R. Emergency Gynaecology. Best Practice & Research Clinical Obstetrics and
Gynaecology. 2006;20(5):729-50.
3.
Ginath. S, Shalev. A, Keiday. R, Kerner. R, Condrea. A, Golan. A, et al. Differences between adnexal
torsion in pregnant and nonpregnant women The Journal of Minimally Invasive Gynaecology.
2012;19:708-14.
4.
McCloskey. K., Grover. S., Vuillermin. P., Babl. F.E. Ovarian torsion among girls presenting with abdominal
pain: a retrospective cohort study. Emergency Medical Journal. 2013;30(e11):2-5.
5.
Pea JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonography in the diagnosis of ovarian
torsion. Fertility and Sterility. 2000 5//;73(5):1047-50.
6.
Grimes. D.A., Jones. L.B., Lopez. L.M., Schulz. K.F. Oral contrceptives for functional ovarian cysts The
Cochrane Library. 2011(9):1-28.
National Standards Standard 1 Clinical Practice
Legislation - Nil
Related Policies - Clinical Guidelines Ovarian Hyperstimulation Syndrome.
Other related documents Nil
RESPONSIBILITY
Policy Sponsor
Initial Endorsement
Last Reviewed
Last Amended
Review date
All guidelines should be read in conjunction with the Disclaimer at the beginning of this section
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