Long-term follow-up of patients surgically treated for ruptured ovarian endometriotic cysts.
OBJECTIVE
Approximately 4% of women are admitted to hospitals because of ovarian cyst rupture, hemorrhage, or torsion. Endometriotic cyst rupture is a rare surgical emergency associated with severe peritonitis and pelvic adhesion, and we aimed to determine its prognosis and long-term outcome.


METHODS
We reviewed and analyzed the medical records of 11 patients (mean age, 31.8 ± 7.2 years) with ruptured endometrioma and a history of dysmenorrhea (4.9 ± 2.3 of maximum 10) who were surgically treated, and then regularly followed-up for more than 3 years (range, 35-261 months).


RESULTS
Previous ultrasound examinations revealed pelvic cysts in seven patients. Three patients had a history of endometrioma surgery. In the emergency room, eight patients complained of uterine motion tenderness. Sonography revealed residual ovarian tumors (size range, 4.2-10.4 cm), with or without fluid accumulation in the cul-de-sac. Surgical enucleation by laparoscopy or laparotomy revealed high revised American Fertility Society endometriosis scores (78 ± 20.1) as well as high adhesion scores (48.7 ± 11.3). In the postoperative period, four patients had recurrent ovarian tumors that were related to elevated serum cancer antigen 125 levels and high postoperative pain scores. In contrast, three patients who became pregnant during the postoperative period had low serum cancer antigen 125 levels and pain scores.


CONCLUSIONS
Endometrioma rupture should be considered in females presenting with sudden lower abdominal pain, associated with a history of dysmenorrhea and preexisting pelvic cysts. Emergency surgical intervention may lead to a better prognosis, particularly in patients without a history of previous endometrioma surgery.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei Taiwan.
Yu-Hsin
YH
Huang
Jui-Der
JD
Liou
Chia-Lin
CL
Hsieh
Chii-Shinn
CS
Shiau
Liang-Ming
LM
Lo
Ming-Yang
MY
Chang
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D010048:Ovarian Cysts / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012422:Rupture, Spontaneous; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult