Giant ovarian cyst masquerading as a massive ascites: a case report

Eugene Vernyuy Yeika, Derrick Tembi Efie, Paul Nkemtendong Tolefac, and Joseph Nkeangu Fomengia

Case presentation

Herein, we present the case of a 65-year-old black African woman, who was referred to their centre for the management of a massive ascites. She presented with a 5-year history of progressive abdominal distension. She had no abdominal pain, nausea, vomiting or change in bowel habit but complained of increased urinary frequency. She was a grand multipara with parity of 6 and had no relevant past medical history.

Physical examination revealed pink conjunctivae and anicteric sclerae. Her vital parameters were normal and her weight was 65 kg. Her abdomen was grossly distended with full flanks and visible striae (Fig. 1). It was soft and non-tender with an abdominal girth of 115 cm. Percussion notes were dull over the entire abdomen and fluid thrill was present. Examination of the cardiovascular and urogenital systems were unremarkable.

Giant ovarian cyst masquerading as a massive ascites: a case report
Fig. 1
Grossly distended abdomen with full flanks and visible striae

The following investigations were done: a complete blood count which was normal with a haemoglobin level of 12 g/dl, an abdominal ultrasound scan which was suggestive of a massive fluid-filled multilocular cavity of right ovarian origin with a thin covering and bowel loops shifted against the diaphragm. Other haematological or biochemical serum tests were normal. We concluded on the diagnosis of a right giant multiloculated ovarian cyst.

Following counselling and consent, a right ovarian cystectomy was done through a laparotomy with a midline incision (Fig. 2). Intraoperative findings included a GOC arising from the right ovary with a gelatinous hyper vascularised membrane. The cyst was excised with membranes intact and it measured 55 × 52 × 24 cm and weighed 10.8 kg (Fig. 3). Histopathology revealed mucinous cystadenoma. The postoperative period was uneventful and she was discharged on the 5th postoperative day with a weight of 54 kg.

Fig. 2
Abdomen showing the midline incision
Fig. 3
Excised cyst with membranes intact