[Rupture of hemorrhagic ovarian cysts. Value of celioscopic surgery]

The rupture of haemorrhagic cysts of the ovary occur frequently and are often missed. Review of the literature and an analysis of our series of 20 patients makes it possible to summarise the typical clinical picture, which is of a young woman who has sudden severe pelvic pain in the second half of her menstrual cycle, during intercourse, or when she has pelvic trauma. Ultrasound in 90% of cases shows up signs suggesting the diagnosis and these are: a mass beside the uterus, or an intra-abdominal effusion. Endoscopic surgery is indicated particularly in women of reproductive age who suffer this pathology which is always benign. The indications to treat the patients should always take in to account the histology; 100% of these are luteal cysts. There is no reported case of cancer of the ovary or of an organic haemorrhagic cyst. On the other hand occasionally a primary ovarian pregnancy may occur and that can be confused with a haemorrhagic cyst. Finally haemorrhagic cysts can occur with an intra-uterine pregnancy and this means that the corpus luteum must be preserved. We propose the following treatment for those cases with symptoms: simple peritoneal washout when pregnancy has been ruled out on the laparoscopy exploration and when the bleeding is widespread: systematic taking of a biopsy for histology if there is the slightest doubt that there is a pregnancy in the ovary and an intraperitoneal removal of the cyst when haemorrhage persists during the operation.