Massive Ovarian Cyst - Is Surgery the Only Option?

Reproductive age group women face many challenges and disorders including ovarian masses. Ovarian cyst diagnosed in the reproductive age group are generally benign.1 Benign ovarian cysts, if diagnosed early when small (< 5 cm diameter), usually resolve spontaneously and do not require surgical intervention whereas very large cysts (> 10 cm in size) usually require surgical removal.2 A case of massive benign ovarian cyst in a reproductive age group woman, treated without a major surgical intervention is being reported.Ovarian tumours like simple benign cysts (thin-walled cysts with no solid structures or calcifications) less than 5 cm diameter usually resolve over 2 menstrual cycles, out of which 10 percent of patients may undergo surgical intervention at some point during their lifetime,2 because of pain or perceived risk of torsion. But, on the other hand giant ovarian cysts undergo surgical removal by laparotomy or by endoscopy. Laparoscopy for removal of giant cysts (> 10 cm) has gained importance. On its flipside, laparoscopic surgery has a few morbidities like formation of post-operative adhesions, which can compromise future fertility, although, less than laparotomy.In the present case, a young unmarried childbearing age woman underwent ultrasound guided needle drainage of benign massive ovarian cyst for over 5 hours and 7.5 liters of fluid was removed with shorter duration of hospital stay and follow up was done in OPD. After 3 months of follow up, the patient has no symptoms, cyst size had not increased, and she was leading a normal life. In young women, it is also desirable to avoid unnecessary surgery as much as we can, to avoid complications and risks, keeping future fertility in mind. The management rationale is to do conservative management where possible and prevent or reduce patient morbidity by avoiding surgical methods like laparotomy and laparoscopic operations wherever possible after proper patient selection.

Bicornuate Uterus with Unilateral Fibroid - Surgical Procedure or LNG-IUS - A Conservative Approach in a Patient Who Opted LNG as Contraception

Bicornuate uterus with leiomyoma is rare. A 30 - year - old patient with bicornuate uterus with fibroid presented with abnormal - uterine - bleeding and was treated non - surgically with LNG - IUS. Uterine fibroids and AUB affect the quality of life and remain a leading indication for hysterectomy. In young women, uterine preservation approaches should be preferred as far as possible.Abnormalities in fusion or formation of Mullerian duct results in uterine structural and functional abnormalities.1 One of the Mullerian duct anomalies, bicornuate uterus, occurs due to incomplete fusion of utero-vaginal horns at the level of fundus. Bicornuate uterus is the most common Mullerian duct anomaly (25 % of cases )2,3 and association of bicornuate uterus with leiomyoma is very rare and there have been very few cases reported till now.4,5 A case of bicornuate uterus with unilateral fibroid is being reported who presented with abnormal uterine bleeding and pelvic pain and was treated non-surgically with LNG - IUS.

Silent uterine rupture in second trimester: a differential diagnosis to remember

Spontaneous silent uterine rupture is a life-threatening emergency situation requiring immediate laparotomy. High index of suspicion is key to prevent maternal mortality as at times the presentation can be nonspecific. Authors herein present a case of spontaneous silent uterine rupture during second trimester of pregnancy wherein the diagnosis was initially missed. To the best of authors knowledge, only a few cases with spontaneous fundal second trimester uterine rupture have been recorded so far.