🩺 Case Report: Laparoscopic Ovarian Cystectomy in Advanced Pregnancy
A 30-year-old pregnant woman at 33 weeks of gestation presented with the sudden onset of severe abdominal pain. During her 20-week anomaly scan, she was diagnosed with a 6 cm ovarian cyst, which was suspected to be a benign tumor. At 33 weeks, this cyst had undergone torsion, leading to the acute symptoms.
She was taken up immediately for emergency laparoscopic surgery. The surgical team anticipated several challenges including difficulty in port placement, limited operative space due to advanced pregnancy, bleeding from a congested pedicle, and the need to operate from the same side of the pathology due to limited access.
Despite these challenges, the team proceeded with laparoscopic cyst removal. The wellbeing of the mother and baby was continuously monitored throughout the procedure. A laparoscopic ovarian cystectomy was successfully performed, carefully preserving the ovarian tissue. The total duration of the surgery was 40 minutes.
The patient recovered well and was discharged within 48 hours. She continues to be followed up with regular antenatal care.
🩺 General Discussion
Ovarian cysts complicating pregnancy occur in approximately 0.5% of all pregnancies. These are often identified during early pregnancy scans and are usually asymptomatic. However, torsion of ovarian cysts is more common in pregnant women than in non-pregnant women. Cysts larger than 5 to 6 cm are particularly prone to torsion. Torsion can also occur in the puerperium (postpartum period).
Symptoms such as sudden severe lower abdominal pain and vomiting should raise suspicion of torsion. These symptoms can sometimes be confused with common early pregnancy complaints. Diagnosis is primarily confirmed by ultrasound, although MRI may be required in some cases.
Laparoscopy is considered safe during any trimester of pregnancy. In cases where surgical intervention is needed, laparoscopic cystectomy offers many advantages — including less postoperative pain, reduced need for analgesics, and faster recovery.