Presentation
Acute lower abdominal pain for 7 hours. Peritonitic abdomen. Exclude intra-abdominal pathology.
Patient Data
A moderate amount of free fluid is seen surrounding the liver and spleen and within the pericolic gutters. Hyperdense fluid is seen within the pelvis, with a mixed density structure at the level of the right adnexa measuring approximately 3.8 x 4.3 x 4.6 cm. Hyperdense material associated with the right adnexal mass is suspicious for extravasation of contrast due to active hemorrhage into an ovarian cyst. The left ovary demonstrates numerous follicles.
No evidence of free gas within the abdomen or pelvis. The appendix is not dilated. A linear hypodensity is seen posteriorly within the spleen.
Normal appearance of the liver, gallbladder, pancreas and adrenal glands. Suspected small cortical cyst in the midpole of the right kidney. No small or large bowel abnormality identified.
The lung bases are clear. Bilateral pars defects within L5, no acute osseous pathology identified.
IMPRESSION
- Findings are in keeping with hemorrhage of a right adnexal lesion, likely an ovarian cyst in the setting of a negative beta-hCG. Further evaluation with ultrasound may be of value.
- Linear hypodensity within the spleen may represent a focal laceration, however the surrounding fluid is more hypodense than in the pelvis and is less likely without a history of trauma. A small cleft would be more likely.
Within the right adnexa is a heterogeneous mass with maximal dimensions of 78 x 65 x 52 mm (volume 140 mL) arising within the ovary. Small amount of vascularity seen within the mass. Small amount of pelvic free fluid. Normal size and appearance of the left ovary with maximal dimensions of 45 x 28 x 16 mm (volume 11 mL).
The uterus has an anteverted orientation with normal size and appearance, 45 x 25 x 41 mm (volume 24 mL). No focal uterine lesion. Endometrium is uniformly thin.
IMPRESSION
- Findings are most in keeping with a ruptured right ovarian cyst.
- Small amount of free pelvic fluid demonstrated however, when compared to the CT abdomen/pelvis the hemorrhagic right ovarian cyst is the most likely source of the large volume hemoperitoneum.
Case Discussion
Laparoscopy was performed which identified a right ovarian corpus luteal cyst, with hemostasis achieved with cauterisation. There were large clots in the pelvis and hemoperitoneum surrounding liver. The spleen was normal.
The patient recovered uneventfully.
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