-
Obstetrics and Gynecology Aug 2021To examine the effects of intraoperative ovarian capsule rupture on progression-free survival and overall survival in women who are undergoing surgery for early-stage... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To examine the effects of intraoperative ovarian capsule rupture on progression-free survival and overall survival in women who are undergoing surgery for early-stage ovarian cancer.
DATA SOURCES
MEDLINE using PubMed, EMBASE (Elsevier), ClinicalTrials.gov, and Scopus (Elsevier) were searched from inception until August 11, 2020.
METHODS OF STUDY SELECTION
High-quality studies reporting survival outcomes comparing ovarian capsule rupture to no capsule rupture among patients with early-stage epithelial ovarian cancer who underwent surgical management were abstracted. Study quality was assessed with the Newcastle-Ottawa Scale, and studies with scores of at least 7 points were included.
TABULATION, INTEGRATION, AND RESULTS
The data were extracted independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between ovarian capsule rupture and oncologic outcomes. Seventeen studies met all the criteria for inclusion in the meta-analysis. Twelve thousand seven hundred fifty-six (62.6%) patients did not have capsule rupture and had disease confined to the ovary on final pathology; 5,532 (33.7%) patients had intraoperative capsule rupture of an otherwise early-stage ovarian cancer. Patients with intraoperative capsule rupture had worse progression-free survival (hazard ratio [HR] 1.92, 95% CI 1.34-2.76, P<.001), with moderate heterogeneity (I2=41%, P=.07) when compared with those without capsule rupture. Pooled results from these studies showed a worse overall survival (HR 1.48, 95% CI 1.15-1.91, P=.003), with moderate heterogeneity (I2=53%, P=.02) when compared with patients without intraoperative capsule rupture. This remained significant in a series of sensitivity analyses.
CONCLUSION
This systematic review and meta-analysis of high-quality observational studies shows that intraoperative ovarian capsule rupture results in decreased progression-free survival and overall survival in women with early-stage ovarian cancer who are undergoing initial surgical management.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42021216561.
Topics: Disease Progression; Female; Humans; Intraoperative Complications; Ovarian Neoplasms; Ovary; Progression-Free Survival; Rupture; Survival Rate
PubMed: 34237756
DOI: 10.1097/AOG.0000000000004455 -
The Journal of International Medical... May 2023To clarify the clinical characteristics and laparoscopic surgical outcomes of dermoid cysts complicated by spontaneous rupture. (Review)
Review
OBJECTIVE
To clarify the clinical characteristics and laparoscopic surgical outcomes of dermoid cysts complicated by spontaneous rupture.
METHODS
This was a single-center retrospective observational study of patients with dermoid cysts treated between January 2005 and December 2021.
RESULTS
Among 1205 cases of dermoid cysts, spontaneous rupture occurred in nine and torsion occurred in 83 cases. No obvious triggers for rupture were identified, except for one postpartum case with fundal uterine pressure maneuver. Rupture was identified by computed tomography (CT) in six cases. Patients with ruptured cysts had significantly higher serum C-reactive protein (CRP), cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma antigen (SCC) levels compared with patients with uncomplicated dermoid cysts or cysts with torsion. Laparoscopic management was possible except for one case with severe adhesion, which required laparotomy. Two patients required prolonged postoperative administration of antibiotics due to refractory chemical peritonitis.
CONCLUSION
Combined use of CT imaging and elevated levels of CRP, CA125, CA19-9, and SCC may help to differentiate cyst rupture from torsion. Laparoscopic surgery may be a feasible option; however, prompt laparotomic conversion should be considered in cases with difficult adhesiolysis. Refractory chemical peritonitis may occur after successful surgical management.
Topics: Female; Humans; Dermoid Cyst; Rupture, Spontaneous; CA-19-9 Antigen; Retrospective Studies; Laparoscopy; Ovarian Neoplasms; Peritonitis; Burns, Chemical; C-Reactive Protein; CA-125 Antigen; Treatment Outcome; Observational Studies as Topic
PubMed: 37138472
DOI: 10.1177/03000605231171023 -
Cureus Sep 2022Despite the relatively high incidence of ovarian cysts, particularly in premenopausal women, cyst rupture may on occasion present painfully and require surgical...
Despite the relatively high incidence of ovarian cysts, particularly in premenopausal women, cyst rupture may on occasion present painfully and require surgical intervention to resolve. Particularly in the case of ruptured hemorrhagic ovarian cysts, resulting hemoperitoneum can create a risk of further adverse events including hypovolemic shock; proper identification and management of such cases are therefore critical. This case focuses on a 22-year-old female that presented to the emergency department (ED) with suprapubic pain in the lower left quadrant of the abdomen. Ultrasonography and computed tomography of the abdomen and pelvis revealed a ruptured hemorrhagic corpus luteum cyst of the left ovary and secondary hemoperitoneum. Patient treatment required laparoscopic left ovarian cyst wall removal, with the removal of hemoperitoneum.
PubMed: 36284799
DOI: 10.7759/cureus.29350 -
The Journal of Obstetrics and... Apr 2015Spontaneous rupture of an ovarian artery aneurysm most commonly presents with abdominal pain in a multiparous woman in the early post-partum period. Aneurysms of the... (Review)
Review
Spontaneous rupture of an ovarian artery aneurysm most commonly presents with abdominal pain in a multiparous woman in the early post-partum period. Aneurysms of the ovarian artery have been reported in the published work very infrequently. In our case, a 31-year-old multiparous woman experienced sudden left lower quadrant abdominal pain on the second post-partum day. Angiography showed rupture of a left ovarian artery aneurysm, which was successfully embolized using gelatin sponge particles. The patient resumed menstruation 3 months after the embolization and concurrently conceived, ultimately giving birth at term without complications. Interventional radiology appears to be a highly safe and effective technique for diagnosis and management of a ruptured ovarian artery aneurysm with minimal risk of impairing subsequent fertility.
Topics: Abdominal Pain; Adult; Aneurysm, Ruptured; Embolization, Therapeutic; Female; Humans; Ovary; Postpartum Period; Treatment Outcome
PubMed: 25370370
DOI: 10.1111/jog.12561 -
The Journal of Obstetrics and... Mar 2015It is rare for an ovarian artery aneurysm to rupture during the peripartum period, but the outcome can be catastrophic. Between 1980 and 2013, only nine cases have been... (Review)
Review
It is rare for an ovarian artery aneurysm to rupture during the peripartum period, but the outcome can be catastrophic. Between 1980 and 2013, only nine cases have been reported in the English-language medical published work. We describe a patient with a left ovarian artery aneurysm that ruptured 4 days after an uneventful vaginal delivery. The rupture was immediately identified, using emergent computed tomography and angiography. The hemorrhage was managed using arterial embolization and blood transfusion, allowing for a successful outcome. The possibility of ruptured ovarian artery aneurysm should be considered in the differential diagnosis for women with excessive or localized abdominal pain after childbirth.
Topics: Abdominal Pain; Adult; Aneurysm, Ruptured; Arteries; Embolization, Therapeutic; Female; Humans; Ovary; Postpartum Period; Rupture, Spontaneous
PubMed: 25256954
DOI: 10.1111/jog.12535 -
Cureus Aug 2022The rupture of ectopic ovarian pregnancy accompanied by massive intra-abdominal bleeding is a rare obstetric complication, occurs predominantly in the first trimester of...
Rupture of Ectopic Ovarian Pregnancy Accompanied by Massive Intra-abdominal Bleeding and Disorder of the Coagulation Mechanism: A Rare and Life-Threatening Obstetric Complication.
The rupture of ectopic ovarian pregnancy accompanied by massive intra-abdominal bleeding is a rare obstetric complication, occurs predominantly in the first trimester of pregnancy, and can be dangerous and life-threatening for the pregnant woman. Our case describes a 37yr old woman with a history of 4 lower segment Cesarian sections (LSCS) (Caesarean sections) and multiple surgical abortions, presenting at the ER with acute abdomen symptoms. The patient's hemodynamic status was unstable. The positive urine pregnancy test combined with the clinical and ultrasound findings established the diagnosis of the ruptured ectopic pregnancy, and immediate surgical treatment was decided. During surgery, a large amount of blood was found in the peritoneal cavity, resulting from a rupture of the right ovary and accompanied by hemorrhagic infiltration of adjacent tissues, without participation in the damage of the ipsilateral fallopian tube. It was deemed necessary to remove the ipsilateral adnexa and whole blood transfusion. The patient was discharged from our department on the fourth postoperative day. The price of beta-chorionic gonadotropic hormone was on a downward trend. Three weeks later, the level of beta-chorionic gonadotropic hormone was zero. In the present paper, a brief review is attempted regarding the diagnostic and therapeutic approach for patients with ruptured ectopic ovarian pregnancy after describing the case.
PubMed: 36127987
DOI: 10.7759/cureus.28112 -
Journal of Obstetrics and Gynaecology :... Apr 2021The majority of patients with benign ovarian cysts undergo laparoscopic surgery using both cystectomy and stripping techniques. However, these techniques have difficulty...
The majority of patients with benign ovarian cysts undergo laparoscopic surgery using both cystectomy and stripping techniques. However, these techniques have difficulty correctly identifying cleavage planes and are prone to cyst rupture. We present a surgical cystectomy technique that correctly identifies the cleavage plane with a low risk of ovarian cyst rupture, even in patients with multicystic ovarian cysts. Cystectomy was performed using Maryland forceps with gentle open and close dissecting motions only. Both the surgeon and assistant handled the ovarian cortex and cyst wall, and soft traction between the cortex and cyst wall as far as the nearby dissection plane without grasping the cyst wall was essential. In patients with multicystic ovarian cysts, making a plane at the notch between cysts decreases the risk of cyst rupture. This technique allows the correct identification of the cleavage plane for dissection and avoids the risk of cyst rupture.Impact Statement The majority of patients with benign ovarian cysts undergo laparoscopic surgery using both cystectomy and stripping techniques. These techniques have difficulty correctly identifying cleavage planes and are prone to cyst rupture. This technique allows the correct identification of the cleavage plane for dissection and avoids the risk of cyst rupture. Our technique might be useful for the preservation of the ovarian reserve because patients in this study had a low proportion of ovarian follicles in the surgical specimen.
Topics: Adolescent; Adult; Dissection; Female; Humans; Intraoperative Complications; Ovarian Cysts; Ovariectomy; Ovary; Retrospective Studies; Rupture; Treatment Outcome; Young Adult
PubMed: 32496929
DOI: 10.1080/01443615.2020.1755622 -
Ginekologia Polska 2019A twenty-eight-year-old female patient during the second pregnancy, about 6 hbd (according to the date of the last menstrual period) from the spontaneous cycle, was...
A twenty-eight-year-old female patient during the second pregnancy, about 6 hbd (according to the date of the last menstrual period) from the spontaneous cycle, was directed to the local hospital because of suspected ectopic pregnancy with the location of the fallopian tube on the left side. She had no symptoms and vital parameters were in normal range. It was revealed that three years ago ectopic pregnancy of the right uterine tubule ended with right fallopian tube removal.
Topics: Adult; Female; Gestational Age; Gynecologic Surgical Procedures; Gynecological Examination; Hemorrhage; Humans; Laparoscopy; Ovary; Pregnancy; Pregnancy, Ectopic; Rupture; Treatment Outcome
PubMed: 31909468
DOI: 10.5603/GP.2019.0125 -
The Journal of Obstetrics and... Sep 2021During pregnancy, the ovarian endometrioma generally decreases in size and occasionally ruptures. We evaluated (1) whether and how ovarian-endometrioma size changes from...
AIM
During pregnancy, the ovarian endometrioma generally decreases in size and occasionally ruptures. We evaluated (1) whether and how ovarian-endometrioma size changes from the first trimester to the postdelivery period, and (2) the type of endometrioma more likely to rupture during pregnancy.
METHODS
During an 18-year period (2000-2018), ultrasound in the first trimester revealed ovarian endometrioma in 149 pregnant women at our tertiary institute. Among these, we subjected 138 endometriomas in 145 patients to expectant management (wait-and-watch approach during pregnancy). We compared the cyst sizes in the first trimester and the postdelivery period, and defined a >1 cm diameter size-change as a significant increase/decrease. We analyzed four patients with rupture and characterized the predictors of rupture.
RESULTS
A comparison of cyst sizes in the first trimester and the postdelivery period revealed that the size of 94 (68%), 37 (27%), and 7 ovaries (5.0%), respectively, decreased, remained unchanged, and increased; in 56 ovaries (40%), apparent cysts were no longer present. Of the 145 patients, four (2.8%) required emergency surgery for cyst rupture. Adhesion to the surroundings, an increase in cyst size, large size (diameter of ≥6 cm), and compression due to the enlarged uterus in late pregnancy were factors clinically related to rupture.
CONCLUSIONS
Approximately two-thirds of ovarian endometriomas decreased in size during pregnancy (40% disappeared), 27% remained unchanged, and only 5% increased in size. However, 2.8% of pregnant women with endometrial cysts experienced rupture. We characterized risk factors for rupture; however, clinical application requires further evaluation.
Topics: Endometriosis; Female; Humans; Ovarian Cysts; Ovarian Diseases; Ovary; Pregnancy; Pregnancy Trimester, First; Risk Factors; Ultrasonography
PubMed: 34155737
DOI: 10.1111/jog.14862 -
Journal of Medical Case Reports Apr 2015Spontaneous rupture of an ovarian artery aneurysm is extremely rare. Although a majority of these cases have been associated with pregnancy, there have been recent... (Review)
Review
INTRODUCTION
Spontaneous rupture of an ovarian artery aneurysm is extremely rare. Although a majority of these cases have been associated with pregnancy, there have been recent reports and reviews of rare cases that were not directly associated with pregnancy. Transcatheter arterial embolization is considered to be an alternative therapy to surgery.
CASE PRESENTATION
A 44-year-old Japanese woman, gravida 3 para 3, presented to our emergency room complaining of intermittent right flank pain. She had undergone a cesarean section 2 years previously, and had no history of abdominal trauma. On admission, her blood pressure was 115/78 mmHg, pulse 70 beats per minute, and hemoglobin concentration 9.8 g/dL. Abdominal ultrasonography and contrast-enhanced dynamic computed tomography revealed a large retroperitoneal hematoma. Findings on three-dimensional computed tomography angiography suggested ruptured aneurysm of her right ovarian artery. A selective right ovarian artery angiogram revealed a tortuous aneurysm. Transcatheter arterial embolization using N-butyl-2-cyanoacrylate was performed. The aneurysm was successfully embolized, and her course after embolization was uneventful. She has remained symptom-free during 3 months of follow-up.
CONCLUSIONS
This was a very rare case of a patient who had a retroperitoneal hemorrhage originating from an ovarian artery aneurysm. A review of published case reports found that contrast-enhanced computed tomography with reconstruction images is an excellent imaging tool. Diagnostic angiography and subsequent transcatheter arterial embolization are thought to be very effective for this condition.
Topics: Adult; Aneurysm, Ruptured; Angiography; Aorta, Abdominal; Contrast Media; Embolization, Therapeutic; Female; Flank Pain; Hemorrhage; Humans; Ovary; Rupture, Spontaneous
PubMed: 25902845
DOI: 10.1186/s13256-015-0553-4