Case of Double Ovarian Cyst
BJOG: an International Journal of Obstetrics and Gynaecology
IT would seem very improbable that an ovarian tumour of about the size of a full-time foetal head could be overlooked during a laparotomy. The oversight waa committed under the following circumstances. Mrs. E. H., a mnltipara of 68 years, had thought that her abdomen waa unduly enlarged for some eighteen years. It had certainly been rapidly increasing in size for three years. There had been alight uterine hzemorrhage for two months. She was a thin, feeble woman, with greatly thickened arteries
... thickened arteries and extensive chronic bronchitis. The abdomen was enormously enlarged by a cystic swelling, the greatest diameter being 47 inches. She was a very bad subject for operation, and it was very desirable' that an uncomplicated ovarian cyst should be found. There was no free fluid and no adhesions. The cyst was tapped and 26 pints of fluid easily removed from three large loouli. It was then seen that the cyst extended deeply into the left broad ligament and the pelvic meso-colon. It had also dragged the uterus up into the abdomen. It was necessary to put the patient into the Trendelenberg position to facilitate the pelvic dissection. This was carried out satisfactorily, and the cyst was removed with the body of the uterus. No time was then lost in closing the abdomen, and the condition of the right uterine appendages was not noted. There were no abdominal complications, but a sharp attack of bronchitis caused considerable anxiety for several days. Thereafter progress waa steady until nearly three weeks after the operation, when the patient was sitting up. She then complained of slight abdominal pain. This recurred on the following three days, and became more severe. On removing the binder a swelling was plainly visible, bulging the thin abdominal wall t o the right of the umbilicus. It was slightly tender and of the shape of an ovid disc, with irregularly-rounded edges. It was freely movable, and could be readily pushed under the left costal margin. There was no rise of temperature and no intestinal symptoms. In considering its nature it seemed impossible that a tumour of the right ovary of the size of this swelling could have been overlooked during the first operation. The absence of any rise of temperature and of intestinal symptoms, together with the free mobility, were taken to negative it being due to a swab or other foreign body. On February 13th, 1914, the abdomen was opened.