Silent Threat: Bilateral Giant Asymptomatic Endometriotic Cysts With Unilateral Sudden Rupture-A Case Report

Area of Science:

• Gynecology
• Reproductive Medicine
• Surgical Pathology

Background:

• Endometriotic cysts are common gynecological findings.
• Bilateral giant endometriotic cysts are exceptionally rare, particularly in asymptomatic individuals.
• Cyst rupture, though uncommon, presents diagnostic challenges due to peritoneal irritation.

Observation:

• A 25-year-old woman presented with acute symptoms including nausea, vomiting, and an enlarging abdominal mass.
• Ultrasonography demonstrated bilateral ovarian cystic masses with characteristic "ground glass" appearance and subhepatic free fluid.
• Emergency laparotomy revealed a ruptured right ovarian endometriotic cyst (20 cm) with extensive adhesions and a contralateral cyst (12 cm).

Findings:

• Histopathology confirmed bilateral endometriotic cysts.
• The patient underwent right salpingo-oophorectomy, left ovarian cystectomy, and ureterolysis due to the rupture and adhesions.
• Surgical intervention was critical for managing the acute presentation and extensive adhesions.

Implications:

• Prompt surgical management of ruptured endometriotic cysts is vital to minimize adhesion formation and preserve ovarian function and fertility.
• Postoperative hormonal therapy is recommended to reduce the risk of recurrence.
• This case highlights the importance of considering rare presentations of endometriosis, even in the absence of typical symptoms.