Poster Session
Context Fertility sparing surgery in a young woman who despite dieting was investigated because of weight gain and abnormal liver function. Imaging diagnose an enormous abdominal cyst with gross mass-effect on abdominal organs and lungs. Objective To illustrate the technical difficulties in operating on massive ovarian masses, and the difficulty in transferring the specimen from the operating table to a suitable container. Methods – Case report Patient A 26 year-old obese nulliparous woman was referred for a liver ultrasound due to mildly elevated liver enzymes, and weight gain despite dieting. The ultrasound showed a large abdominal cystic mass, and a further CT scan showed this to be of ovarian origin with gross mass-effect on abdominal organs. A CA-125 of 40 KU/L and an MDT discussion classified this as an intermediate risk. The patient had an episode of acute onset shortness of breath and a chest x-ray and CTPA were done to exclude pulmonary embolus, this however, only showed further mass-effect of the ovarian cyst on the lungs. Intervention A long mid-line laparotomy was done. The surgery proved technically difficult in view of constant risk of rupture of cyst contents due to manipulation. Access to the pelvic cavity was limited. Once the cyst-oophorectomy was done, the challenge was transferring the enormous cyst from the operating table onto a transport container. The weight, size, slippery surface, and risk of content rupture, added to this challenge. Results The cyst was weighed at the lab at 26.6kg, measuring 506x220x302mm with a smooth capsular surface. It was unilocular with dark brown fluid and no solid areas. Histology showed a benign seromucinous cystadenoma with no evidence of borderline changes or malignancy. There were further areas of haemorrhage and haemosiderin deposits consistent with torsion. Omental biopsies and peritoneal washings were also negative. Conclusions Excellent theatre team work and improvising manual handling of the enormous cyst made the surgery a success. The initially distended abdomen was closed to a concave resulting appearance, and normalising of the patient’s BMI. The patient made a full recovery without complications. Rapidly enlarging ovarian cysts of this size are rare. With advances in laparoscopic surgery, the foundations of open surgery can still provide challenges. This size cyst, and initial concerns of malignancy resulted in a reassuring, benign success story worthy of the headlines.