The study of emergency laparoscopic surgery for gynecological diseases: Can we predict the rupture of ovarian endometriotic cyst?

Objective: We investigated emergency laparoscopic surgery for gynecological disease in our hospital, and analyzed the clinical characteristics of patients and findings of ruptured vs. un-ruptured ovarian endometriotic cyst.Design: From April 2005 to March 2009 and April 2009 to September 2010, we treated a total 1,847 patients by laparoscopic surgery at Nagasaki Municipal Hospital (1251 cases) and Saiseikai Nagasaki Hospital (596 cases). We retrospectively analyzed operative reports, video images and laboratory data.Result: The frequency of emergency operation was 18% (334/1,847cases) during this period. Preoperative clinical diagnosis was as follows: ectopic pregnancy (166 cases), torsion of ovarian tumor (55 cases), ovarian bleeding (43 cases), ruptured ovarian endometriotic cyst (37 cases), pelvic inflammatory disease (11 cases), and other (20 cases). Among the 37 patients with suspected cases of ruptured ovarian endometriotic cyst before surgery, 10 cases were found un-ruptured at laparoscopic surgery. Among the 43 patients diagnosed preoperatively with ovarian bleeding, two cases were found to be ruptured endometriotic cyst at laparoscopic surgery. We compared cases in the ruptured group (n=29) versus the un-ruptured group (n=10) according to preoperative clinical and laboratory findings including age of the patient, affected site (right or left), body temperature, tenderness of cul-de-sac, rebound tenderness, leukocyte count, serum CRP/CA125 level, diameter of the tumor, and MRI findings. We found that the age of the patient (33.6 ± 7.8 vs. 28.1 ± 5.1yrs), the leukocyte count (11,993 ± 4,127 vs. 8,500 ± 4,046/μl), and the incidence of rebound tenderness (96% vs. 22%) were significantly higher in the ruptured group when compared with the un-ruptured group. Conclusion: A substantial proportion of patients with ovarian endometriotic cyst were found with ruptured cysts during emergency laparoscopic surgery at our hospital. Although it is relatively difficult to accurately diagnose ruptured ovarian endometriotic cyst, careful physical examination and clinical investigation are essential in the preoperative assessment of patients with suspected ruptured ovarian endometriotic cyst.