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Diagnosis and management of a giant ovarian cyst in the gravid-puerperium period: a case report

Sibraogo Kiemtoré,1,2Hyacinthe Zamané,1,2Yobi Alexis Sawadogo,1Rodrigue Sansan Sib,3Evelyne Komboigo,2Ali Ouédraogo,1 and Blandine Bonané1,2

Sociodemographic characteristics of the patient

The patient was a 25-year-old woman who dropped school early and got married with a single farmer. She lived with her husband in Kongoussi, a rural commune about 100 km from Ouagadougou, the capital city of Burkina Faso. She did not have any income-generating activity. She had her first menses at 16 years old. She was third gravida and third para with three living children.

Diagnostic approach

For her previous pregnancy, the date of the patient’s last menses was not known and no dating ultrasound was performed. She received prenatal care at the health center of her village, but no paraclinic investigation was carried out during her pregnancy.

On November 18th, 2018, the patient gave birth to a baby boy at health center of her village. At birth, the baby had Apgar’s score of 8/10 at the first minute, 10/10 at the 5th minute, and weighed 2780 g. The patient reported that after her last delivery her abdomen had remained large as compared to previous deliveries. She also said to have noticed a gradual increase in the volume of her abdomen in the days following delivery. As she unsuccessfully went through traditional care made of decoction, 10 days after giving birth, she decided to go back to the health center of her village for consultation. From this center, she was referred to the Department of Obstetrics Gynecology at Yalgado Ouedraogo University Hospital Center in Ouagadougou, 27 days after giving birth, i.e. on December 15, 2018. At admission, she was complaining of tension-type abdominal pain and was dyspnetic. She weighed 93 kg and was 167 cm tall with a temperature of 37°2 C. On inspection, the abdomen was largely distended (Fig. 1). As for the palpation, it revealed an enormous abdominopelvic mass with a dull note on percussion. The abdominal perimeter was 126 cm long.

Fig. 1
Abdominal distension before removal of abdominal cyst

An ultrasound found a cystic abdominopelvic image without being able to attach it to an organ. It was then that a Computed tomography (CT) was performed. This CT also showed a fluid mass with no evidence of solid components or septations (Fig. 2). In this regard, the radiologist discussed two diagnoses: a giant ovarian cyst and a huge mesenteric cyst. The tumor marker CA-125 was normal and the haemoglobin blood level was 14.5 g per deciliter.

Fig. 2
abdominopelvic unilocular cyst by CT scan

Treatment

We performed a midline laparotomy from the lower abdomen up to the umbilicus (Fig .3) that allowed the externalization of the cyst located in the left ovary (Fig. 4). The uterus and contralateral adnexa were macroscopically normal. We then carried out a left total oophorectomy. The removal of the latter giant ovarian cyst allowed an exploration of the entire abdominal cavity. But we did not find any ascites or abnormalities of the other intraperitoneal organs (Fig. 5). The abdominal wall was closed by some simple interrupted sutures. The fascia was closed with decimal 4 polyglactin sutures and the skin with decimal 3 non-absorbable sutures. The patient’s abdomen turned flat immediately after surgery (Fig. 6). The removed cyst measured 42 cm long-axis and weighed 19.7 kg (Fig. 7). The postoperative period was uneventful and the patient was released from the hospital on the 3rd day after surgery. No complications were observed in the 45 days after surgery. At the histological study, the cyst was benign and was viewed as a serous ovarian cystadenoma.

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Fig. 3
incision from in the lower abdomen up to the umbilicus
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Fig. 4
externalization of the giant cyst
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Fig. 5
exploration of the entire abdominal cavity; no ascites, no abnormalities of the other intraperitoneal organs found
Fig. 6
abdomen turned flat immediately after surgery
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Fig. 7
giant ovarian cyst after removal (19,7 kg and 42 in cm in diameter)

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