Ovarian cysts are common in ovulating women of reproductive age due to physiologic cyst formation from ovulation and, therefore, typically occur 2-3 weeks after the last menstrual period. and occur when fluid fills the space of the recently released follicle following ovulation (ie, corpus luteal cyst).
acute onset of pelvic pain and a cystic ovarian mass with a moderate amount of free fluid in the pelvis
Physiologic ovarian cysts are usually small (eg, <3 cm) and asymptomatic, but they can become larger and rupture with vigorous activity (eg, intercourse).
risk for ovarian cysts likely increases due to discontinuation of her combined OCPs that typically suppress cyst formation.
Patients typically have acute-onset, unilateral pain due to cyst rupture and spilling of fluid into the peritoneal cavity; some patients may also have associated bleeding, causing additional peritoneal irritation.
The Q didn’t have acute abdomen on examination →”The abdomen is soft and tender to palpation in the right lower quadrant”
In general, ruptured ovarian cysts are benign and cause minimal lower abdominal pain. However, in patients on anticoagulation (as in this patient being treated for deep vein thrombosis), cyst rupture can cause significant intraabdominal bleeding (ie, hemoperitoneum). Patients classically have unilateral lower abdominal pain that becomes increasingly diffuse, often radiating to the shoulder (due to phrenic nerve irritation). As blood fills the abdominal cavity, patients also develop peritoneal signs (eg, rigidity, rebound, guarding) and hemodynamic instability (eg, hypotension, tachycardia).
Diagnosis is confirmed by ultrasound, which typically reveals a simple, thin-walled ovarian cyst with free fluid in the pelvis.
Diagnosis can be confirmed by pelvic ultrasound, which typically reveals heterogeneous pelvic free fluid and a possible ovarian cyst (if not completely drained).
Management of a ruptured ovarian cyst is based on hemodynamic stability. Hemodynamically stable patients with no signs of infection (eg, fever) are managed with observation and reassurance. In contrast, those who are hemodynamically unstable may have continued bleeding from the ruptured cyst and require emergency surgery (eg, diagnostic laparoscopy).
(Choice B) CT scan of the abdomen and pelvis is indicated in patients with an acute abdomen (eg, rebound/guarding) or concern for malignancy (eg, complex-appearing ovarian mass), which are not present in this patient.