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Abstract: The patient is a 26-year-old pregnant woman with lower abdominal cramps, irregular, and so far not accompanied by abnormal vaginal bleeding. The abdominal pain worsened yesterday and she came to our hospital for further treatment. Ultrasound suggested: mixed echogenicity in the left adnexal region, no echogenicity in the uterine cavity, ruptured ovarian cyst, pelvic effusion and intrauterine pregnancy, where ruptured ovarian cyst is short for ruptured ovarian corpus luteum as well as ruptured corpus luteum. The ruptured ovarian cyst was repaired through surgical treatment. The patient was discharged without discomfort after surgery.
Basic information】Female, 26 years old
Type of disease】Intrauterine pregnancy, ruptured left ovarian cyst, female pelvic adhesions
Hospital】Heilongjiang Provincial Hospital
Date of Consultation】May 2022
Treatment plan] Surgical treatment (single-port laparoscopic left ovarian cyst removal + pelvic adhesion release + diagnostic curettage) + medication (cefazolin sodium for injection + metronidazole injection)
Treatment period】3 days of inpatient treatment and 1 month of outpatient follow-up
Treatment effect】Ruptured ovarian cyst was repaired, and the patient was discharged without discomfort after surgery.
I. Initial consultation
The patient’s last menstrual period was on April 1, 2022, and she started to have lower abdominal pain on May 7, which was irregular until now, without abnormal vaginal bleeding, no fever, no diarrhea or constipation, and no feeling of urgency. On May 22, she underwent B-HCG test: 1975.21 miu/ml. Yesterday, the abdominal pain worsened, and ultrasound showed mixed echogenicity in the left adnexal region, no echo in the uterine cavity, left adnexal cyst and pelvic fluid. Blood cell analysis: low erythrocytes, hemoglobin and erythrocyte pressure product, and elevated platelets, suggesting possible active bleeding in the abdominal cavity. On admission, he had a painful face, temperature: 36.1℃; pulse: 96 beats/min; respiration: 20 breaths/min; blood pressure: 106/69 mmHg. There was pressure pain and rebound pain in the abdomen.
II. Treatment history
The diagnosis of intrauterine pregnancy combined with ruptured left ovarian cyst and female pelvic adhesions was confirmed by emergency laparoscopic exploration: ruptured left ovarian cyst, intrauterine pregnancy, and female pelvic adhesions. A single-port laparoscopic excision of the left ovarian cyst + pelvic adhesions release + diagnostic curettage was performed under general anesthesia, and postoperative vital signs were stable and the abdominal incision dressing was clean and in place. Routine postoperative examination and treatment care, vital signs monitoring. Postoperative rehydration, cefazolin sodium for injection + metronidazole injection was given intravenously to prevent infection. The urinary catheter was removed 24 hours after surgery, venting, resuming diet, and discharged from the hospital in 3 days.
III. Treatment effect
After the patient was admitted to the hospital, the relevant examinations were completed, and it was clear that intrauterine pregnancy, ruptured ovarian cyst and intra-abdominal bleeding were present, so we communicated with the patient to stop the bleeding with emergency surgery. She was cured and discharged successfully.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. We also instructed the patient to pay attention to relaxation, ensure sufficient sleep, combine work and rest, and live a regular life after discharge; abstain from sex for one month, pay attention to diet to increase nutrition, eat high-protein food, such as eggs, fish, chicken, etc., and eat more vegetables and fruits to maintain balanced nutrition and avoid indigestible food. Ensure smooth bowel movement and avoid constipation. After 1 month, we will review the ultrasound and blood count in the clinic after menstruation.
V. Personal insight
Ruptured ovarian cyst is a common gynecological emergency with sudden onset, obvious abdominal pain and urgent condition of the patient, requiring emergency hospitalization and emergency surgery to stop bleeding if symptoms are obvious and there is a lot of intra-abdominal bleeding. In addition, because luteal cysts may be combined in pregnant patients with the possibility of spontaneous rupture, if there is sudden lower abdominal pain in early pregnancy without relief and accompanied by anal swelling, there is a possibility of ovarian cyst rupture and the patient needs to come to the hospital immediately. After diagnosis, surgery should be performed as soon as possible if there is an indication for surgery to prevent the patient from bleeding a lot over time and causing anemia.