Diagnosis and management of ovarian cyst accidents

Ovarian cyst accidents include cyst rupture, haemorrhage and torsion. Torsion commonly occurs to the whole adnexa and is not necessarily associated with an ovarian cyst. Suspected adnexal torsion should always be managed with early laparoscopy and de-torsion of the twisted tube or ovary. Ovarian cyst rupture and haemorrhage usually occur in association with physiological (functional) cysts and are generally self-limiting. Laparoscopy may be necessary in cases where the diagnosis is in doubt or for haemodynamic compromise. Clinical features of ovarian cyst accidents are nonspecific. Ultrasound is the first-line investigation and is diagnostic in the case of haemorrhage. Typical ultrasound findings have been described for ovarian torsion, including an enlarged oedematous ovary with peripheral displacement of follicles. Doppler blood flow findings are variable and not diagnostic. Recurrent cyst rupture or haemorrhage should be prevented by suppression of ovulation, usually with the combined oral contraceptive. Fixation of the ovary by a variety of techniques should be considered to prevent recurrent torsion.