169. Baguio Days 6, 7, 8, 10: Ovarian "Accidents"

Ovaries produce and secrete (release) hormones and fluids that help prepare an immature ovum (egg cell) for its big meeting with Mr Sperm;  the same hormones have systemic effects as well, including but not limited to skin, joints, gastrointestinal, central nervous system.  Most of these secretions take place within the monthly ovulatory (aka follicular) cyst. But there are also abnormal cysts, what we used to call ovarian accidents.

Sometimes the ovary thinks it can reproduce without the help of a sperm, resulting in a dermoid cyst, which does grow and differentiate—mainly into nerve, cartilage, hair, and fat cells. But that’s about it; no virgin birth here. These cysts can become quite large and can rupture (very painful as the contents irritate the lining of the abdominal cavity), twist (also painful), or mask cancer.  So totally worthy of surgical excision.

endometrioma on left with swollen left fallopian tube;
uterus is normal as is the opposite ovary and tube.

Less dramatic are the cysts that just secrete fluids, such as Remerlita’s, or the almost as large cyst of 31 year old Ailyn.  Though suspicious for malignancy because of nodules on the lining of the cyst, her age, and normal screening blood tests suggested otherwise, so we proceeded with removal without assistance of a gynecologic  oncologist.  Lolita’s “ovarian accident” was an endometrioma, where cells from the uterine lining migrate from the uterus and form an ovarian cyst.  These "endometrioma" cysts are vascular and bleed, forming blood-filled cysts. 

Then came an ER consult: 33 yr old Emma with acute pain and an ultrasound showing an ovarian cyst, possible torsion (twisting, which would explain the sudden onset of pain), and also a fibroid.  She wanted to maintain fertility so our goal was to remove the cyst and the fibroid.  As soon as we entered the abdominal cavity we encountered adhesions between the uterus and bowels.  These were carefully dissected, separating the two organs.  Then a relatively simple removal of an anterior fibroid (about 2 x 3 inches).

But no cyst and no visible ovaries (obscured by adhesions which were left in place; the risk of removing greater than any benefit.  Best explanation: the ultrasound mistook an immobile segment of bowel for a cyst. The usually constant moving bowels are easy to differentiate from immobile ovarian cysts, but when part of the bowel  is stuck to the uterus, it can look like a cyst.