Keywords : diagnostic laparoscopy, ovarian cyst, ascites
Enormous ovarian cysts mimic ascites clinically and
ultrasonographically'. We report a case in which
laparoscopy helped in this differentiation.
A 32 year-old woman presented with massive and progressively increasing abdominal distention since the past 5 years. She had been unsuccessfully investigated outside inclusive of multiple abdominal paracenteses. On examination she had no significant findings other than an enormously gross ascites because of which pelvic organs could not be visualized. Her chest x-ray was unremarkable. Biochemical, cytological and microbiological tests were unremarkable. She was taken up for a diagnostic laparoscopy. Examination under anesthesia resulting in laxity of the anterior abdominal wall kindled the suspicion of a large ovarian cyst. Hassan cannulation was used for insufflation and the cyst was directly visualized. There were no peritoneal signs of malignancy or metastasis. There were some signs of hemorrhage into the cyst. Laparotomy was performed which demonstrated a left torted ovarian cyst weighing 9 kg (Photograph 1). A left ovarian cystectomy was done. Histopathology study showed it to be benign ovarian cystadenoma.
Massive ovarian cysts fill the entire abdomen and can be
easily mistaken for ascites'. The massive distension
inhibits ultrasonic appreciation of pelvic anatomy.
Abdominal paracentesis or unwitting ovarian cyst
paracentesis yields non-specific information on
biochemical, microbiological and cytological
examinations". Examination under anesthesia with
relaxed anterior abdominal wall as a prelude to
diagnostic laparoscopy, can suggest a distinction
between ascites and a large cyst. Diagnostic
laparoscopy is a useful modality in the investigation
of intractable ascites of unknown originv". The blunt
Hassan technique of insufflation is preferred over
the Veress needle. Laparoscopic cystectomy, even
for large cysts is a viable option in a non-malignant
ovarian cyst6,8
