Journal of Reproductive Medicine Gynaecology & Obstetrics Category: Medical Type: Case Series
Minimally Invasive Approach in Treating Large Ovarian Endometrioma
- Bishista Bagchi1, Sugata Bhattacharya2, Gon Chowdhury Rajib1, Siddhartha Chatterjee3*
- 1 Department Of Reproductive Medicine, Calcutta Fertility Mission, Kolkata, India
- 2 Department Of Radiology, Manisha X-Ray Clinic, Kolkata, India
- 3 Department Of Biochemistry And Endocrinology, Institute Of Post Graduate Medical Education & Research, Calcutta Fertility Mission, 21, Bondel Road, Kolkata - 700019, India
*Corresponding Author:Siddhartha Chatterjee
Department Of Biochemistry And Endocrinology, Institute Of Post Graduate Medical Education & Research, Calcutta Fertility Mission, 21, Bondel Road, Kolkata - 700019, India
Received Date: Jul 09, 2019 Accepted Date: Jul 12, 2019 Published Date: Jul 19, 2019
Management of large ovarian endometriomas has been a potential challenge; be it laparoscopy, open approach or drainage of the cystic fluid. The present procedure has been carried out to benefit young yet to conceive patients to restore ovarian function and facilitate conception.
3 patients; one presented with history of increasing abdominal girth, pain and infertility; the other with history of loose motion and acute abdominal pain; the third patient had complaints of abdominal pain and infertility. Radiological investigations revealed large cysts in the right and left ovary in the first and third patients respectively; bilateral complex cystic lesions in the second patient. The tumour markers were moderately high (endometriosis); imaging showed benign appearance. Ultrasound-guided drainage of the chocolate-coloured cystic fluid was done using a pigtail catheter. Postoperative period was uneventful.
Minimally invasive treatment of endometrioma which benefits infertile or unmarried patients by preserving the ovaries and fertility henceforth.
Figure 2: CECT whole abdomen showing bilateral cystic lesions (153*59*48) mm with multiple thick septations and minimally enhancing solid component, arising from right adnexa and (71*56*46) mm complex cyst arising from the left adnexa; Collapsed cyst wall with normal ovaries was seen on ultrasound post procedure.
Figure 3A: Transabdominal ultrasound showing a large pelvic cystic SOL of (120*100) mm; 3B) normal left ovary post procedure.
Figure 4: 1) Flexible Stiffening Cannula 2) Metal Stiffening Cannula 3) Connector 4) Drainage catheter 5) Straightener.
Figure 5: Insertion of pigtail catheter and aspiration of chocolate coloured fluid from the endometrioma.
The advantage of the present procedure is that it is minimally invasive and complete drainage of the chocolate coloured cystic fluid is possible without any spillage or internal haemorrhage. The drainage is done from the non-dependent part of the cyst which reduces the chances of leakage of the content subsequently in comparison to transvaginal aspiration which is usually done through the most dependent part. Asepsis was strictly maintained by painting and draping of the skin and no saline was introduced to prevent any possibility of infection. Sclerotherapy has not yet been standardized, hence we avoided use of any other agent for fear of infection and we had prescribed Dienogest (2mg) to them for some time. Percutaneous needle puncture of cyst is established as an effective procedure for ovarian cyst aspiration but it is difficult to aspirate contents of the cyst completely especially in these cases as endometriotic blood is quite thick to drain, which could be drained easily by the wide-bore pigtail catheter. Use of LHRH analogue helps to delay re-collection of the cyst content and hence recurrence. After the procedure patient can be given ovulation induction with letrozole as it will not re-stimulate endometriosis. Moreover it appears that large-sized endometriomas distort the Tubo-Ovarian Relationship (TOR) and might also have some pressure effect on the ovaries hampering the natural process of ovulation. This can be sited as one of the reasons that one of our patients had conceived with ovulation induction after drainage of endometrioma. The drawbacks of this procedure are small rent in the ovary which usually heals by fibrosis and there might be little bit of spillage of the content of the cyst if the placement of the catheter is improper and recurrence of the cyst as the cyst wall is not excised. But these complications are true even in transvaginal drainage of endometrioma and in laparoscopy. The main advantages of this procedure are preservation of the ovaries of infertile women as well as unmarried young patients seem to outweigh the disadvantages. In addition, the procedure being done under transabdominal ultrasound appears to be convenient for young unmarried patients.
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Citation:Bagchi B, Bhattacharya S, Rajib GC, Chatterjee S (2019) Minimally Invasive Approach in Treating Large Ovarian Endometrioma. J Reprod Med Gynecol Obstet 4: 024.
Copyright: © 2019 Bishista Bagchi, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.