CASE REPORT

OVARIAN CYST
FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN
INTRODUCTION

Ovarian cyst is a sac or a pouch filled

with fluid or other tissue that forms in or
on an ovary
Ovarian cysts are very common and they
can occur during childbearing years of
even after menopause

Most ovarian cysts are benign.

CASE REPORT (HISTORY TAKING)

Date of Admission : June 13th, 2017 (09:51a.m.)

Date of Examination : June 13th, 2017
IDENTITY

Patients Husband

Initial Name Mrs. M Mr. O

Age 63 years old 75 years old

Address Bangsanaya, Lembursitu (Sukabumi)

Ethnic Group Sundanese

Religion Moslem

Occupation Housewife Unemployee

Education Elementary Junior High School

Marital Status Married

 Chief Complaint
Patient came to obgyn clinic (RS. Syamsudin) due to lump in the left side of her abdomen
with abdominal pain since 2 days ago.

History of Present Illness

Patient has been complaining about lump in the left side of her lower abdomen since 3
months ago. Sometimes it felt painful. She also complained about micturition problem
(increase in frequency but decrease in volume) and decrease of appetite. There was history of
ovarian cyst in 1984 (had been operated, last follow up: 5 months ago). She was also having
nausea, vomiting and fatigue.
History of Past Illness History of Family

History of hypertension : (+) History of STD in husband :

History of heart disease: (+), denied
controlled (aspilet) History of hypertension :
History of asthma : denied denied
History of asthma :
History of DM : denied
denied
History of tuberculosis : denied
History of diabetes mellitus :
History of allergy : denied denied
History of trauma : denied History of allergy :
History of past surgery : denied denied
 Menstruation History
Menarche : 12 years old
Menstrual cycle : 28 days, regularly, with duration of 7 days, dysmenorrhea
(-)
Total pads : 2 3 pads/day
Menopause : 55 years old

Contraception History
She has never used any kind of contraception.

Marital History
Married once, been married for 40 years now.
CASE REPORT (PHYSICAL EXAMINATION)
General condition : moderately ill
Consciousness : compos mentis
Vital signs
Blood pressure : 130/80 mmHg
Heart rate : 88 bpm
Respiratory rate : 20 x/minute
Temperature : 36.5C
Nutritional Status
Weight : 46 kg
Height : 152 cm
Body Mass Index (BMI): 19,9
GENERAL EXAMINATION
Head : normocephaly, deformity (-)
Eyes : anemic conjunctiva -/-, icteric sclera -/-
Ear & Nose : deformity (-)
Mouth : wet oral mucosa membrane
Neck : thyroid enlargement (-), trachea is in the
middle
Heart : regular 1st and 2nd heart sounds, murmur -,
gallop -
Lung
Inspection : symmetric chest expansion in both static and
dynamic breathing
Percussion : sonor on both lungs
Auscultation : vesicular breath sounds +/+ regular, rhonchi
-/-wheezing -/-
GENERAL EXAMINATION

Mammae : hyperpigmentation of areola +/+, nipple retraction -/-,

breast milk -/-
Abdomen
Inspection : convex
Palpation : palpable mass (+) above symphysis, tenderness (-).
Auscultation : bowel sound +, 7x/minute

Extremities : warm, CRT< 2s, edema -/-/-/-

GYNAECOLOGIC EXAMINATION

Inspection and Palpation : Vulva edema (-), vaginal discharge (-), scar (-), blood (-),
theres a palpable mass 3 cm above symphysis.
Inspeculo : Not performed
Vagina Toucher : Not performed
Recto Vaginal Toucher : Not performed
LABORATORY EXAMINATION

Types Results Units Normal Value

Hematology:

Hemoglobin 10.6 g/dL 12 14

Hematocrit 33 % 37 47
Leucocytes 8,100 /uL 4,000 10,000
Platelets 360 thousands/uL 150,000
Eritrocyte 3.8 millions/ uL 450,000
MCV 89 fL 3.8 5.2
MCH 28 pg 80 100
MCHC 32 g/dL 26 34
32 36
LABORATORY EXAMINATION

Types Results Units Normal Value

Lipid Profile:

Triglyceride 127 mg/dL <150

<200
Total Cholesterol 291 mg/dL
40-60
HDL Cholesterol 40 mg/dL
<130
LDL Cholesterol 226 mg/dL
(direct)
LABORATORY EXAMINATION

Types Results Units Normal Value

Heart Enzyme:
CKMB 9.0 ng/mL <24

Electrolyte:
137-150
Sodium 148 mmol/L
3.5-5.5
Potassium 3.2 mmol/L 8-10.4
Calcium 7.8 mg/dL

Tumor Marker: 0-35

Ca 125 57.6 U/mL

OTHER EXAMINATIONS

BNO IVP (May 30th, 2017)

Identation of superior wall of urinary bladder due to pressure from certain mass.
Excretion function is decreased

Thorax X-Ray (May 30th, 2017)

Cardiomegaly

USG (April 18th,2017)

Cystic multilocular mass sized 8.6x8 cm in right uterus.

 Working Diagnosis

Susp. Dyspepsia
Susp. Ovarian Cyst

Final Diagnosis

Ovarian Cyst
 Management

Aspilet
Omeprazole
Domperidone
Meloxicam
R/ hysterectomy operation

Prognosis

Quo ad vitam : bonam

Quo ad functionam : bonam
Quo ad sanationam : dubia ad bonam
FOLLOW UP (JUNE 14TH, 2017)

Subjective Objective Assessment Planning

Post operation wound General condition : moderately ill Mrs. M, 63 years old, post Vital sign observation
pain Consciousness : compos mentis operation hysterectomy due to
Laboratory result observation
Vital signs ovarian cyst
BP : 130/70 mmHg Mobilization training
Pulse : 56 bpm
Pain Assessment
RR : 20 x/minute
T : 36.3C Antibiotic and Analgesic

No abnormality of the wound

Pain scale 6/10
Dry oral mucosa
Mobilization (-)
CASE ANALYSIS
DIAGNOSIS
HISTORY TAKING
CASE
lump in the left side of her abdomen
with abdominal pain since 2 days
ago.
Patient has been complaining about
lump in the left side of her lower
abdomen since 3 months ago
Sometimes it felt painful.
Micturition problem (increase in
frequency but decrease in volume)
Decrease of appetite. Nausea,
vomiting and fatigue.
history of ovarian cyst in 1984 (had
been operated, last follow up: 5
months ago).
Helm, CW, Ovarian Cyst. March 19, 2008. Available
http://emedicine.com/med/topic1699.htm.
THEORY
Ovarian cyst is usually
asymptomatic. It usually causes
symptoms if it ruptures, large, or
blocks the blood supply of the ovary.
Ovarian cyst is more likely to cause
pain if it becomes large, bleeds,
ruptures, interfere with blood supply
of ovary, bumped during sexual
intercourse, or torsion of Fallopian
tube.
If it presses the rectum, it can
causes constipation. If it presses the
urinary bladder, it can cause
increasing of urination because the
bladder capacity decreases.
Sudden and severe pelvic pain, often
withatnausea and vomiting, maybe
sign of torsion of ovary on its blood
PHYSICAL EXAMINATION

CASE THEORY

General condition : A mass might be palpable on

moderately ill abdominal examination.
Vital sign : Within Abdominal examination may
normal limit reveals moderate to severe
Abdominal unilateral or bilateral lower
Abdomen abdominal tenderness in some
Inspection women with ovarian cyst.
: convex
Hemorrhage due to cyst
Palpation : palpable mass
rupture may lead tachycardia
(+) above symphysis, and hypotension
8.6x8 cm, tenderness (-).
Advanced malignant disease
Auscultation: bowel sound
may be associated weight loss,
+, 7x/minute lymphadenopathy, shortness
of breath, and signs of pleural
Med Clin North Am. 2008 Sept., 92(5): 1253-71, xii. Williams Gynecology, ch. 16, 21
effusion.
LAB EXAMINATION

CASE THEORY

Hb 10,6 gr/dL () The rupture of ovarian cyst

Hct 33% () can causes anemia, resulting
Total Cholesterol 291 mg/dL low Hb and Hct.
() Low potassium level can be
HDL Cholesterol 40 mg/dL caused by loss of fluid in
() body due to vomiting or
LDL Cholesterol 226 mg/dL micturition problem.
() Post menopausal woman with
CKMB 9.0 ng/dL () elevated CA125 consistent
Potassium 3.2 mmol/L () with malignancy, ascites,
nodular or fixed mass or
Calcium 7.8 mg/dL () evidence of metastases.
CA125
Med 57.6Am.
Clin North U/mL ()
2008 Sept., 92(5): 1253-71, xii. Williams Gynecology, ch. 16, 21
CASE ANALYSIS
MANAGEMENT
OBSTETRICAL COMPLICATIONS

CASE THEORY

Aspilet Main management

Omeprazole for this patient is
Domperidone cystectomy or
Meloxicam hysterectomy to
remove the cyst.
R/ hysterectomy
Drugs given to this
operation
patient is only to
treat the
Med Clin North Am. 2008 Sept., 92(5): 1253-71, symptoms
xii. Williams Gynecology, ch. 16, 21
CASE ANALYSIS
COMPLICATIONS
COMPLICATIONS

CASE THEORY

There was Torsion of ovary; caused by large

no cyst twist an ovary from its
complicatio original position. The blood supply
n in this of ovary is cut off, if not treated it
case. can cause damage or death to
ovarian tissue
Ruptured cyst; can caused intense
pain and internal bleeding. It
increases the risk of infection and
life threatening if untreated.
CONCLUSION

The problem of the patient was a mass around 3 cm

above symphysis

The treatment was a hysterectomy operation to

remove the mass within the uterus.

Diagnosis of ovarian cyst in these patients was

based on history taking, physical examination, and
supporting examination
REFERENCES

Med Clin North Am. 2008 Sept., 92(5): 1253-71, xii. Williams Gynecology, ch. 16,
21
Bottomley C, Bourne T. Diagnosis and management of ovarian cyst accidents. Best
Pract Res Clin Obstet Gynaecol. 2009 Oct. 23(5):711-24.
Katz VL. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby Elsevier.; 2007.
1098-103.
Conway C, Zalud I, Dilena M, et al. Simple Cyst in the Postmenopausal Patient:
Detection and Management. J Ultrasound Med 17:369-72, 1998.