Successful conservative management of ruptured ovarian cysts with hemoperitoneum in healthy women

Abstract

Study objective: To determine the success rate of the "intended conservative management strategy" of ruptured ovarian cysts with hemoperitoneum and the risk factors for surgical interventions in healthy women of reproductive age.

Methods: Patients who visited the emergency department with abdominal pain and were diagnosed with a ruptured ovarian cyst with hemoperitoneum between August 2008 and June 2013 were included in this retrospective study. The diagnosis of the ruptured ovarian cysts and hemoperitoneum was based on the clinical symptoms, physical examination and ultrasound and CT imaging. The rate of surgical interventions and the risk factors for surgical intervention were determined.

Results: A total of 78 women were diagnosed with a ruptured ovarian cyst with hemoperitoneum. Most patients (80.8%, 63/78) were managed conservatively, and 19.2% of the patients (15/78) required a surgical intervention. In the multiple logistic regression analysis, the diastolic blood pressure (dBP) (odds ratio [OR] of 0.921 with 95% confidence interval [CI] of 0.855-0.993) and the depth of the total pelvic fluid collection in CT (DTFC_CT) (OR 1.599 with 95% CI 1.092-2.343) were the significant determining factors of surgical intervention after adjustment. The rate of surgical intervention was 6.5% vs. 15.8% vs. 77.8% in the patients with neither dBP ≤ 70 mmHg nor DTFC_CT ≥ 5.6 cm, those with only one of those features, and those with both, respectively.

Conclusion: Most cases of ruptured ovarian cysts with hemoperitoneum can be managed conservatively. A low diastolic blood pressure and a large amount of hemoperitoneum suggest the need for surgical intervention.

Figure 1. CT quantification of hemoperitoneum.

The depth in the anterior cul-de-sac and the posterior cul-de-sac are defined the distance from the anterior peritoneum to the anterior uterine wall and the distance from the posterior uterine wall to the rectum, respectively.

Figure 2. The rate of surgical intervention according to the absence or presence of risk factors.

*, p<0.05 compared to the cases with neither a dBP≤70 mmHg nor a DTFC_CT≥5.6 cm; †, p<0.05 compared to cases with either a dBP≤70 mmHg or a DTFC_CT≥5.6 cm. The proportions were compared with Fisher’s exact test.