Ovarian cyst

Case No.
 Patient’s ID

Husband identity
Name : Mrs. F Name : Mrs. F
Age : 26 yrs Age : 26 yrs
Address : Pasaman Barat Address : Pasaman Barat
MR Number : 01 03 9565 MR Number : 01 03 9565
Time of admission : Feb 09th, 2019 Time of admission : Feb 09th, 2019
Anamnesis

A 28 years old patient was admitted to

The General Hospital of Dr. M. Djamil
Padang on Feb 09th, 2019 at 03.00 am,
referred from RSUD Pasaman Barat with
diagnosed ovarian cyst on G1P0A0H0 23-
24 weeks of pregnancy
 Present Illness History
 Swollen in stomach since 1 month ago, bigger more and
more, initially equal to adult fist and now equal to baby’s
head, pain was denied
 Blood leakage from vagina outside menstrual periode was
denied
 Post coital bleeding history (-), dispareunia (-)
 Patient was married with 9 children, smallest age was 1years
 Nausea (-), vomit (-) and decrease of body weight
 Urinary and bowel was normal
 Menstruation history: Menarche at 13 years old, its cycle was
reguler for lasth 3 months, once a month, 5-7 days in duration
with 2-3x pad change/day without pain.
 Previous Illness History
 There was no history of cardiac disease, lung
disease, liver disease, renal disease, diabetes
mellitus, hypertension, nor allergy.

Familial Illness History

 There was no history of any hereditary, contagious,
or psychiatric disorder.
 Marriage history: married once in 2018

Obstetric history : Pregnancy/Abortion/Delivery: 1/0/0

1. present
Educational history : Senior High School graduate

Occupational history : housewife

History of family planning : (-)

Immunization : (-)
 Physical Examination

GC Cons BP HR RR T BW BH BMI

Mdt CMC 120/80 82 20 37° 45 150 20,4

Eyes : conjunctiva was not anemic, sclera was not icteric

Neck : JVP 5-2 cmH2O, no enlargement of thyroid gland
Thorax : Heart & lung were in normal limit
Extremity : oedema -/-, PF +/+, PT-/-
 GYNECOLOGY RECORD

Abdomen

 Inspection : Seemed enlarged in accordance with

preterm 9 month pregnancy, cicatrix (-)
 Palpation : mass was palpabled at 2 finger under
PX, round shape, cystic consistency, mobile,
pressure pain (-), tenderness pain (-), DM (-)
 Percution : deaf above mass
 Auscultation : peristaltic sound was normal
Genitalia: I: V/U normal, Vaginal bleeding (-)
Inspeculo
Vagina: Tumor (-), laceration (-), Fluxus (-)
Portio: MP, equal to adult fist,tumor (-), laceration (-),
fluxus (-), OUE was closed
Bimanual VT:
Vagina: tumor (-)
Portio : MP, equal to adult fist, tumor (-),
motion less when mass moved, OUE was
closed, motion pain (-)
CUT : AF, equal to chicken egg
A/P : weaken right, under pool mass was
palpabled at left adnexa
CD : not protruded
USG
USG

 Janin hidup tunggal intrauterine

 Aktivitas gerak janin cukup
 BPD 5,79 HC 20,14
 AC 18,41 FL 4,16
 EFW 599 gr FHR 167gr
 Plasenta grade 1 di korpus depan
 Tampak massa hipoechoic di samping
fundus uteri dengan echo …(+),
berbatas tegas, berlobus ukuran
melebihi layar monitor
 k/ gravid 23-24 minggu sesuai biometri
 Janin hidup
 Kista ovarium
 Laboratory Finding

Parameter Result Normal Value Unit

Haemoglobin 11,6 12.00-14.00 g/dl

Leukocyte 13.950 5.00-15.00 103/mm3

Eritrocyte 4,1 4.00-5.00 106/µl

Thrombocyte 256 150.00-400.00 103/mm3

Hematocrit 32 35.00-43.00 %

APTT 11,6 27-32 Pg

PT 28,2 10-14 g/dl

 Laboratory Finding

Parameter Result Normal Value Unit

SGOT 46 <50 g/dl

SGPT 51 <50 103/mm3

Total protein 7,5 4.00-5.00 106/µl

Albumin 4,24 3,5-4,5 103/mm3

kreatinin 0,92 <1 %

GDS 86 <150 fL

Ca 125 30,9 >50 Pg

 Urinalisis

 Protein :-
 Glukosa :-
 Leukosit : 1-2/LPB
 Eritrosit : 0-1/LPB
 Silinder : -/LPK
 Epitel : Gepeng +
 Bilirubin :-
 Urobilinogen : +
Diagnosis :

• Left Ovarian cyst

Management :

• Control general condition, vital sign, acut

abdomen signs
• Antibiotics (Skin test)
• Preparation of blood transfusion (Crossmatch)
• Consult to OR and anesthesiologist
• Informed Consent

Planning : elective laparatomy

At April 25th 2013 12.40 AM : laparatomy was performed

After peritoneum was opened, mass was palpabled fulfill cavum

abdomen, cystic consistency, equal to baby’s head, reddish
brown color, surface flatten.
Exploration was done and mass came from left ovarian, equal to
baby’s head, surface flatten, cystic consistency, torsion (+), right
ovarian was normal
Impression : torsion left ovarian cyst
Plain/ left salphingooovarectomy
Left salphingooovarectomy was performed  PA
Bleeding was ± 200 cc
Diagnosis :
• Post left salphingooovarectomy oi torsion left
ovarian cyst

Management :
• Post surgery observation
Thank You..