Supervised by:
dr. Mutawakil J. Paransa, Sp.OG
Presented by:
Laila Farhana
2011730147
CHAPTER I
INTRODUCTION
Ovarian cysts are one form of the disease attacking women repoduksi. Cyst or tumor is a
form of interference that can be said the growth of smooth muscle cells in the ovary that
jinak. although thus it is possible to be a malignant tumor or cancer. Course of the disease is
often called sillent killer or secretly causing many women do not realize that he had been
stricken with ovarian cysts and only found out when the cyst is already palpable from the
outside or enlarged.
Every month, during the menstrual cycle, an egg is released from the ovary in a process
called ovulation. Travelling eggs from the ovaries through the fallopian tube to the uterus.
The ovary also a major source of the female hormones estrogen and progesterone. These
hormones affect the development of the female breast, body shape, and body hair. These
hormones also regulate the menstrual cycle and pregnancy.
CHAPTER II
CASE REPORT
II.1 Patient Identity
Name
: Mrs. E
Age
: 28 years old
Nationality
: Indonesian
Address
Marital Status
: Married
Occupation
: Housewife
Religion
: Moslem
Date of Visit
: denied
History of curettage
: denied
History of hypertension
: denied
History of stroke
: denied
History of allergic
: denied
History of asthma
: denied
Menstruation History
Menarche
: 12 years old
Menstrual cycle
Date
Gestational Age
Labor History
Sex
Birth
O
1.
2.
3.
2005
2010
2013
Vaginal delivery
Vaginal delivery
Vaginal delivery
M
M
F
Weight
3000
3200
3000
4.
This pregnancy
: good
Consciousness
: compos mentis
Blood pressure
: 120/80 mmHg
Heart rate
: 96 bpm
Respiratory rate
: 20x/m
Temperature
: 36,5oC
Weight
: 45 kg
Height
: 153 cm
: 19,23 kg/m2
BMI
General Examination
Eyes
Mouth
Heart
Lung
Inspection
Percussion
: resonant +/+
Abdomen
Inspection
: rounded shape
Palpation
Obstetric Examination
Inspection
: convex
Palpation
: fundus impalpable
defans local and tenderness in the left iliac region
no palpable mass
:-
Hemoglobin
Hematocrit
Leucocyte
Erythrocyte
Platelets
: 12,0 gr/dL
: 35%
: 18.600/L
: 4.1 juta/L
: 284.000/L
USG Examination
Interpretation :
looks picture enlarged uterus with a single fetus. fetal movement (+), pulsatif (+), 1011 weeks gestation
II.6 Follow up
15-10-2016
s
Scar pain (-)
0
General
A
condition: salpingo-oophorectomy
moderate ill
weeks
Height
with
of
10-11
Antibiotic
analgesic
pregnancy
: gravida
the
patient
is
discharged,
II.7 Prognosis
Functionam
: Dubia ad Bonam
Sanationam
: Dubia ad Bonam
Vitam
: Dubia ad Bonam
CHAPTER III
CASE ANALYSIS
Patient mrs. E age 28 years old came to emergency department RSUD R. SYAMSUDIN,
S.H., with the main complaint of the lower left abdominal pain since 3 days ago. Based on
the results of anamnesis, physical examination, and investigations, in patients final diagnosis
G4P3A0 Gravida 10-11 weeks with Torsion Ovarian Cyst.
Whether the diagnosis made correctly ?
Whether the management of this patient correct ?
is there any effect on pregnancy ?
1. whether the diagnosis made correctly?
The ovary is one important part of the female reproductive organ system. However, fluidfilled sacs called cysts can grow into it. These cysts are usually harmless, but can be a serious
medical problem if it causes ovarian cyst twisted / (torsion). Watch for signs and symptoms
of the cyst so that torque can be identified and treated early.
factors causing the cyst twisted
Trauma
Uterine contractions in pregnancy
Intestinal peristalsis
mass in the ovary is one that is quite often found in gynecology. Most of the ovarian mass is
functional ovarian cysts and the rest is a benign mass. Ovarian cysts can be divided into two
kinds of ovarian cysts and neoplasms of functional ovarian cysts. Lower abdomen Lower
abdominal pain is an indicator of torque cyst. Pain in the form of a dull pain in the lower
abdomen from time to time continue to grow great to unbearable. irregular menstruation
because most ovarian cysts are usually formed during the menstrual cycle, so that it can
disrupt the menstrual cycle, make your period come earlier or later than usual.
According to the theory for this case torsio cyst lot of reproductive age is 20-44 years.
According to anamnesis of the symptoms in the can Lower abdominal pain (dull pain, pain is
usually increasingly severe), fever, nausea and vomiting, irregular menstruation. In case
patient age 28 years complaint lower left abdominal pain, nausea, vomiting, irregular
menstruation. Classically, the woman with adnexal torsion complains of sharp lower
abdominal pain with sudden onset that worsens intermittently over several hours. The pain
usually is localized to the involved side, with radiation to the ank, groin, or thigh. Low-grade
ever suggests adnexal necrosis. Nausea and vomiting requently accompany the pain.
Lack of clear physical ndings can make diagnosis difficult. An adnexal mass may not be
palpable, and during its early stages, signi cant discom ort may not be elicited during
examination. Sonography plays an essential role. However, sonographic findings can vary
widely depending on the degree of vascular compromise, the characteristics of any associated
intraovarian or intratubal mass, and the presence or absence of adnexal hemorrhage.
Sonographically, torsion may mimic ectopic pregnancy, tuboovarian abscess, hemorrhagic
ovarian cyst, and endometrioma. Accordingly, rates o correct diagnosis range rom 50 to 75
percent
Was the management of this patient correct ?
Torsion / rotation stalk stalk may occur in ovarian cysts with a diameter of 5 cm or more.
Conditions that facilitate torque is pregnancy and after childbirth.
In pregnancy, the enlarged uterus will change the location of the cyst, while in labor may
occur after sudden changes in the abdominal cavity.
Torsion on tumor stem will cause disruption for venous circulation is depressed, there is
blood in the dam resulting tumors greater tumor with bleeding inside. If the torque continues
hemorrhagic necrosis will occur and if left unchecked can occur with a tear in the cyst wall
from bleeding or inflammation intra adominal sekunder with the clinical manifestations of
acute abdomen. So, the most appropriate action for the management of torque cysts are
laparotomy.
Salvage of the involved adnexa, resection of any associated cyst or tumor, and possible
oophoropexy are treatment goals. Findings of adnexal necrosis or rupture with hemorrhage,
however, may necessitate removal of adnexal structures. Torsion may be evaluated by
laparoscopy or laparotomy. Previously, adnexectomy was usually done to avoid possible
thrombus release and subsequent embolism during untwisting. Evidence does not support
this. McGovern and coworkers (1999) reviewed nearly 1000 cases of torsion and ound the
rare occurrence of pulmonary embolism in only 0.2 percent. T ese cases of embolism were
associated with adnexal excision, and none were linked to untwisting of the pedicle. In a
study of 94 women with adnexal torsion, Zweizig and associates (1993) reported no increased
morbidity in women undergoing untwisting o the adnexa compared with those undergoing
adnexectomy.
Management during pregnancy does not different. However, if the corpus luteum is removed
be ore 10 weeks gestation, progestational support is recommended until 10 weeks gestation
Patients with ovarian cysts in pregnancy should be aware if there is suspicion of a cyst but is
accompanied by signs of early pregnancy. Cyst must be detected accurately. Because in
passing, ovarian cysts form similar to the corpus luteum. Corpus Luteum is the rest of the
nest egg that did exist during pregnancy. If the Corpus luteum taken as presumed as ovarian
cysts (ovary), there can be a miscarriage, because it serves to maintain the corpus luteum
hormone function during early pregnancy. Later, after the placenta is formed, then this
function will be taken over by the placenta.
in this case a cyst torsion (twisting), which is already required for surgical indications for
decision that cyst because of severe pain and can disturb the mother and fetus.
in this case, if the cyst is maintained during pregnancy, will be complications, that is;
acute abdomen
abortion
premature birth
CHAPTER IV
CONCLUSION
Patient mrs. E age 28 years old came to emergency department RSUD R. SYAMSUDIN,
S.H., with the main complaint of the lower left abdominal pain since 3 days ago. Based on
the results of anamnesis, physical examination, and investigations, in patients final diagnosis
G4P3A0 Gravida 10-11 weeks with Torsion Ovarian Cyst.
The ovary is one important part of the female reproductive organ system. However, fluidfilled sacs called cysts can grow into it. These cysts are usually harmless, but can be a serious
medical problem if it causes ovarian cyst twisted / (torsion). Watch for signs and symptoms
of the cyst so that torque can be identified and treated early.
factors causing the cyst twisted
Trauma
Uterine contractions in pregnancy
Intestinal peristalsis
Torsion / rotation stalk stalk may occur in ovarian cysts with a diameter of 5 cm or more.
Conditions that facilitate torque is pregnancy and after childbirth.
In pregnancy, the enlarged uterus will change the location of the cyst, while in labor may
occur after sudden changes in the abdominal cavity.
So, the most appropriate action for the management of torque cysts are laparotomy.