Divyesh V. Shukla MD – Shilpi D. Shukla
Vadodara Institute of Minimal Access Surgery .VIMAS, Vadodara, India.

Case report. A 42 year old diabetic patient presented with acute abdominal pain for 1 week with fever for five days. She presented no bowel or bladder symptoms. She had a previous Cesarean Section thirteen years earlier. No contraceptives methods were used. Vital signs were normal except for tachycardia.

The examination showed an abdomen soft at palpation, tenderness in the lower part, no palpable masses.
The peristalsis was present. Vaginal examination revealed about 8 cm size soft mass felt through fornix with tenderness.

The uterus was enlarged. Laboratory tests showed moderate anemia, leukocytosis & thrombocytosis. Transvaginal ultrasound showed a bulky uterus and a 7 cm, unilocular, thick walled right ovarian cyst, with contents having fine internal echoes. The left ovary was normal. There were no free fluid in the pelvis. The probe movements caused tenderness. At laparoscopy, bilateral tubal-ovarian masses covered by the omentum were present. After removing the omental adhesions, a right tubal-ovarian mass was seen with adhesions with small and large bowel. The pouch of Douglas was completely obliterated.

Adhesiolysis, ovariolysis, enterolysis were performed, cutting through correct anatomical planes.
The accidental rupture of the right cyst drained pus in the pelvis. A thorough suction and washing was performed. After restoration of the normal anatomy, a right adnexectomy was performed.