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CASE REPORT Anna
CASE REPORT Anna
Supervised by:
dr. Mutawakil J. Paransa, Sp.OG
Presented by:
Laila Farhana 2011730147
Menstruation History
Menarche : 12 years old
Menstrual cycle : iregularly happens, 3-4 days duration, no history
of dysmenorrhea.
Amount of menstrual blood : 2-3 normal pads / day
First day of last menstruation : july, 30th 2016
Contraception History
History of using injected and oral contraception.
Marital History
Married once, has been going on for 11 years.
Gestational History
NO Date Gestational Age Labor History Sex Birth
Weight
1. 2005 9 years old (life) Vaginal delivery M 3000
2. 2010 6 years old (life) Vaginal delivery M 3200
3. 2013 3 years old (life) Vaginal delivery F 3000
4. This pregnancy
General Examination
Eyes : anemic conjunctiva -/-, icteric sclera -/-
Mouth : wet oral mucosa membrane
Heart : regular 1st and 2nd heart sounds, murmur -/-, gallop -/-
Lung
Inspection : symmetric chest expansion in breathing
Percussion : resonant +/+
Auscultation : VBS +/+, rhonchi -/-, wheezing -/-
Mammae : hyperpigmentation of aerola +/+, nipple retraction -/-
Abdomen
Inspection : rounded shape
Palpation : supple in all abdominal region, tenderness
Auscultation : bowel sound +
Extremities : warm, edema -/- -/-, CRT < 2 second
Obstetric Examination
Inspection : convex
Palpation : fundus impalpable
defans local and tenderness in the left iliac region
no palpable mass
Fetal Heart Rate : +
His :-
Vaginal toucher : Fluksus (-)
portio : rubbery, closed ostium
A/P Sinistra : palpable cystic adnexal mass, tenderness (+)
USG Examination
Interpretation :
looks picture enlarged uterus with a single fetus. fetal movement (+), pulsatif (+), 10-
11 weeks gestation
looks picture cyst with a diameter of 8 x 6 cm
II.4 Diagnose
Ny. E, 28 years old G4P3A0 Gravida 10-11 weeks with the left ovarian cyst torsion
II.5 Management
Laparotomy and antibiotics
II.6 Operation Report
Begins operation : 20.45 pm
Exploration : the impact of the left ovarian cyst with a diameter 8x6 cm with a torque
2x 360
gravidarum enlarged uterus
abnormality (-)
tubes and ovaries normal right
Diagnosis: ovarian cyst torsion of the left
Plan : Salpingo oophorectomy sinistra
Finish Operation : 21.15 pm
II.7 Final Diagnosis
Salpingo-oophorectomy post on indications cyst torsion with 10-11 weeks of pregnancy
gravida
II.6 Follow up
s 0 A P
15-10-2016 Scar pain (-) General condition: salpingo-oophorectomy wound care operation
moderate ill post on indications cyst Antibiotic
Level of consciousnes torsion with 10-11 analgesic
: CM weeks of pregnancy
Fundal Height : gravida
within normal limits
Abomen : signs of
local infection (-)
The surgical wound:
good
II.7 Prognosis
Functionam : Dubia ad Bonam
Sanationam : Dubia ad Bonam
Vitam : Dubia ad Bonam
CHAPTER III
CASE ANALYSIS
Patient mrs. E age 28 years old came to emergency department RSUD R. SYAMSUDIN,
S.H., with the main complaint of the lower left abdominal pain since 3 days ago. Based on
the results of anamnesis, physical examination, and investigations, in patients final diagnosis
G4P3A0 Gravida 10-11 weeks with Torsion Ovarian Cyst.
The ovary is one important part of the female reproductive organ system. However, fluid-
filled sacs called cysts can grow into it. These cysts are usually harmless, but can be a serious
medical problem if it causes ovarian cyst twisted / (torsion). Watch for signs and symptoms
of the cyst so that torque can be identified and treated early.
factors causing the cyst twisted
Trauma
Uterine contractions in pregnancy
Intestinal peristalsis
mass in the ovary is one that is quite often found in gynecology. Most of the ovarian mass is
functional ovarian cysts and the rest is a benign mass. Ovarian cysts can be divided into two
kinds of ovarian cysts and neoplasms of functional ovarian cysts. Lower abdomen Lower
abdominal pain is an indicator of torque cyst. Pain in the form of a dull pain in the lower
abdomen from time to time continue to grow great to unbearable. irregular menstruation
because most ovarian cysts are usually formed during the menstrual cycle, so that it can
disrupt the menstrual cycle, make your period come earlier or later than usual.
According to the theory for this case torsio cyst lot of reproductive age is 20-44 years.
According to anamnesis of the symptoms in the can Lower abdominal pain (dull pain, pain is
usually increasingly severe), fever, nausea and vomiting, irregular menstruation. In case
patient age 28 years complaint lower left abdominal pain, nausea, vomiting, irregular
menstruation. Classically, the woman with adnexal torsion complains of sharp lower
abdominal pain with sudden onset that worsens intermittently over several hours. The pain
usually is localized to the involved side, with radiation to the ank, groin, or thigh. Low-grade
ever suggests adnexal necrosis. Nausea and vomiting requently accompany the pain.
Lack of clear physical ndings can make diagnosis difficult. An adnexal mass may not be
palpable, and during its early stages, signi cant discom ort may not be elicited during
examination. Sonography plays an essential role. However, sonographic findings can vary
widely depending on the degree of vascular compromise, the characteristics of any associated
intraovarian or intratubal mass, and the presence or absence of adnexal hemorrhage.
Sonographically, torsion may mimic ectopic pregnancy, tuboovarian abscess, hemorrhagic
ovarian cyst, and endometrioma. Accordingly, rates o correct diagnosis range rom 50 to 75
percent
In some women, cysts precisely detected during pregnancy. These cysts could have been
there before you get pregnant, but not detected. An increase in estrogen during pregnancy can
indeed trigger a cyst enlargement. Ovarian cysts during pregnancy may grow in the ovaries
which is where most overgrown tumor. Tumors in the form of cysts, solid, and the effect on
the mechanism of action of hormones. In pregnancies with ovarian cysts occur as if the
seizure of the room, where the pregnancy continues to expand.
During does not interfere with pregnancy, cysts generally be left as she monitored whether to
shrink, disappear, fixed size, or even larger. Cysts are small and do not exaggerate generally
will not interfere with pregnancy and fetal growth. Only cysts Woe (above 7 cm) which is
feared likely to cause complications and gravity in pregnancy such as miscarriage, premature
birth and infant mortality.
Cysts may interfere with the development of the uterus if its existence until urgent abdominal
cavity. Fetal growth may be hampered because of the blood vessels that supply oxygen and
food ingredients for infant hampered by being pressured by the cyst. Large cysts can cause
abnormal location of the fetus in the womb, or impede the decline in the head in the birth
canal during delivery. Therefore, when the permanent large cysts, it is necessary surgery at
about 18 weeks gestation.
At position cysts in the pelvis, delivery can be interrupted and require the completion of the
road cesarean section operation. At position ovarian cysts in the fundus, delivery can take
place normally, but the dangers of postpartum possible torque cysts and infections to
abscesses. Therefore, immediately after the normal delivery when there is a known ovarian
cyst laparotomy to remove the cyst.
Patients with ovarian cysts in pregnancy should be aware if there is suspicion of a cyst but is
accompanied by signs of early pregnancy. Cyst must be detected accurately. Because in
passing, ovarian cysts form similar to the corpus luteum. Corpus Luteum is the rest of the
nest egg that did exist during pregnancy. If the Corpus luteum taken as presumed as ovarian
cysts (ovary), there can be a miscarriage, because it serves to maintain the corpus luteum
hormone function during early pregnancy. Later, after the placenta is formed, then this
function will be taken over by the placenta.
in this case a cyst torsion (twisting), which is already required for surgical indications for
decision that cyst because of severe pain and can disturb the mother and fetus.
in this case, if the cyst is maintained during pregnancy, will be complications, that is;
acute abdomen
abortion
premature birth
CHAPTER IV
CONCLUSION
Patient mrs. E age 28 years old came to emergency department RSUD R. SYAMSUDIN,
S.H., with the main complaint of the lower left abdominal pain since 3 days ago. Based on
the results of anamnesis, physical examination, and investigations, in patients final diagnosis
G4P3A0 Gravida 10-11 weeks with Torsion Ovarian Cyst.
The ovary is one important part of the female reproductive organ system. However, fluid-
filled sacs called cysts can grow into it. These cysts are usually harmless, but can be a serious
medical problem if it causes ovarian cyst twisted / (torsion). Watch for signs and symptoms
of the cyst so that torque can be identified and treated early.
factors causing the cyst twisted
Trauma
Uterine contractions in pregnancy
Intestinal peristalsis
Torsion / rotation stalk stalk may occur in ovarian cysts with a diameter of 5 cm or more.
Conditions that facilitate torque is pregnancy and after childbirth.
In pregnancy, the enlarged uterus will change the location of the cyst, while in labor may
occur after sudden changes in the abdominal cavity.
So, the most appropriate action for the management of torque cysts are laparotomy.