Mrs. JD, a 41 year old woman came witn severe lower abdominal pain which was followed by abdominal distension and vomiting. It was her fourth day of menses but the menstrual flow was less than the normal flow . She had one full term vaginal delivery 8 years back. Her husband lived away and there was no history of sexual contact.
She was averagely built and nourished. She was pale, her pulse rate was 120 beats / minute and blood pressure 100 /60 mmHg . Abdominal examination showed tenderness and guarding all over with free fluid in the peritoneal cavity. There was no visible peristalsis. On speculum examination, blood stained discharge was seen through cervical os . Vaginal examination showed a normal size uterus and forniceal fullness with tender cervical movements.
The clinical impression was either ruptured ovarian cyst or ruptured ectopic pregnancy. Laboratory investigations revealed hemoglobin of 8.8gm%. Her urinary ptegnancy test was negative.Sonography of the pelvis done 4 months earlier showed normal sized uterus with right ovarian cyst of 3.1 x 2.9 ems. Sonography of the pe lvis done at the time of admission showed.moderate amount of abdominal and pelvic free fluid wi th a 5 x 4 cm mass of heterogenous echotexture in right adnexa.
She was taken for emerge ncy exploratory laparotomy which showed 400 ml hemoperitoneum with old altered blood.Uterus appeared normal. The right ovary showed 7 x 6 ems size cyst which had ruptured and was leaking a chocolate colored material .The left ovary had 3 x 4 ems size chocolate cyst. Both fallop ian tubes appeared thickened, and nflamed, and bowel loops were adherent to the posterior wall of the uterus. The right ovarian cyst wall was excised and the left ovarian cyst was marsupialised retaining normal ovarian tissue. Histopathological report showed bilateral ovarian endometriotic cyst.
