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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 33  |  Issue : 3  |  Page : 307-309

An 8-year review of ovarian cyst accidents at a tertiary health center in Northwestern Nigeria


Department of Obstetrics and Gynecology, ABUTH, Zaria, Kaduna, Nigeria

Date of Web Publication8-Feb-2017

Correspondence Address:
J C Ekweani
Department of Obstetrics and Gynecology, ABUTH, Zaria, P. O. Box 1049, Kaduna 800001
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-5117.199807

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  Abstract 

Background: Ovarian cyst accidents constitute about 3%–5% of gynecological emergencies. They are commonly benign and are of sudden onset. A retrospective study of this nature became necessary because benign diseases of the ovary have not received attention compared to their malignant counterparts.
Methodology: A review of the operation register and patients' case folders was undertaken from January 2008 to October 2015 that underwent laparotomy. Information on the sociodemographics, symptomatology, signs, significant investigation results, findings at laparotomy, and histology was extracted and analyzed using percentages, ratio, and demographic parameters.
Results: Ovarian cyst accidents formed 5.6% of emergency gynecological surgeries. The age range was 19–55 years with a mean 36.2 ± 10.2 years, 42.9% participants were Hausas, 50% Muslims, 71.4% multiparous, and 57.1% amenorrheic. The most common presenting symptom/sign was lower abdominal pains/adnexal tenderness (100%) and none presented with anemia or deranged blood chemistry. Most (66%) had the cyst on the right. The average diameter of the cysts was 9.7 cm, cystectomy was done in 42.9%, and the histology was benign in 100% of the cases.
Conclusion: Most of the cases of ovarian cyst accidents were in the reproductive age group, in multiparous women, benign on histology and were not long-standing sufficiently to alter blood parameters such as the hematocrit and blood chemistry as they presented early due to the acute nature of manifestation.

Keywords: Accidents; cyst; Nigeria; Northwestern; ovarian.


How to cite this article:
Ekweani J C, Oguntayo A, Kolawole A, Zayyan M. An 8-year review of ovarian cyst accidents at a tertiary health center in Northwestern Nigeria. Trop J Obstet Gynaecol 2016;33:307-9

How to cite this URL:
Ekweani J C, Oguntayo A, Kolawole A, Zayyan M. An 8-year review of ovarian cyst accidents at a tertiary health center in Northwestern Nigeria. Trop J Obstet Gynaecol [serial online] 2016 [cited 2020 Aug 15];33:307-9. Available from: http://www.tjogonline.com/text.asp?2016/33/3/307/199807


  Introduction Top


Gynecological emergencies constitute an important part of hospital admissions.[1],[2],[3] Consequent of their presentation as acute abdomen, a high index of suspicion is often required to arrive at a definitive diagnosis.[3] One of such emergencies is the patient presenting with an ovarian cyst which may have undergone torsion, rupture, infection, hemorrhage, or a combination.[3],[4] Ovarian cyst accidents constitute about 3%–5% of gynecological admissions [3],[5],[6] with an incidence of 3%–10%.[2] There was an incidence of 0.67% in a study from Southeastern Nigeria.[7] Although attention has long been given to the malignant counterpart of ovarian lesions because of their complexities, it has also become pertinent to give some attention to the benign.

The ovaries are the female organs of reproduction situated in the pelvis, and though it has a number of supports, it experiences mobility, especially in the diseased state making it vulnerable to accidents. It is a frequent site of neoplastic growths as it often undergoes certain changes under the influence of hormones which it produces.[5] Evidence shows that ovarian lesions in the reproductive age group are often benign; however, reports have also been made of malignant ones.[8],[9],[10],[11] This should be born in mind when approaching the management of such patients, especially when they present as acute cases. Management of these cases can be medical, surgical, or a combination of both. This can involve the administration of antibiotics, intravenous fluids, thromboprophylaxis, blood transfusion, laparotomy, laparoscopy, and robotic surgery.[12],[13],[14] The choice of treatment mode will be determined by the skill of the physician, availability of resources, size, and number of lesion among other factors. The place of histopathological diagnosis is paramount as this will determine if further treatment modalities will be required such as the administration of cytotoxic, ovum harvest for cryopreservation to preserve future fertility, immunotherapy, and radiotherapy.[15],[16]

It became necessary to undertake this review as retrospective studies of this nature have not been recently reported in our center, and there was the need to give some attention to them as against the malignant ones. We thereby present a review of cases managed at the Department of Obstetrics and Gynecology of the Ahmadu Bello University Teaching Hospital, Shika-Zaria from 2008 to 2015. The aim of this study was to review all the cases of ovarian cyst accidents that were managed in our center by laparotomy, namely, their clinical presentation, findings at surgery, and histology.


  Methodology Top


A retrospective review of the operation registers was done at the Obstetrics and Gynecology Department of the Teaching Hospital covering the period January 1, 2008–December 31, 2015 extracting the names and folder numbers of those diagnosed with ovarian accidents and had surgery. This was used to retrieve the folders from the records department of the hospital, and relevant information was retrieved from covering patients' sociodemographic characteristics at the time of admission, mode of symptomology, findings on physical examination, findings on laparotomy, clinical course, and histology findings. Relevant data were analyzed and presented using frequencies, percentages, tables, and deductions made.


  Results Top


A total of 14 case folders were retrieved from the records department. Ovarian cyst accidents formed 5.6% of emergency gynecological surgeries. The age range was 19–55 years with a mean 36.2 ± 10.2 years. 42.9% participants were Hausas, 7.14% Yoruba, 7.14% Igbos, and the other ethnic groups constituted the remaining 42.8%. Fifty percent (50%) participants were Muslims. 71.4% participants were multiparous, 28.6% nulliparous, and 57.1% amenorrheic at the time of presentation. The most common presenting symptom/sign was lower abdominal pains/adnexal tenderness (100%) and none presented with anemia or deranged blood chemistry. Most (66%) had the cyst on the right. The diameter of the cysts ranged from 5 to 14 cm with the average diameter of the cysts being 9.7 cm. Laparotomy was done for all the cases at presentation, and cystectomy was done in 42.9%, ovariectomy in 14.3%, repair in another 14.3%, and marsupialization in 7.1%. The histology was benign in 100% of the cases. [Table 1] shows the intraoperative findings at laparotomy and their percentages. While [Table 2] illustrates the histological diagnosis and frequencies.
Table 1: Intraoperative findings

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Table 2: Histological diagnosis

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  Discussion Top


From the results hitherto presented, ovarian cyst accidents were most common among women of the reproductive age (19–55 years) which may indicate the role that the hormones estrogen and progesterone may play and that played by pregnancy.[8],[9],[10],[11] This agrees with findings from previous studies.[8],[9],[10],[11] Ovarian enlargement in older age groups tends to contain solid components or a combination of both solid and cystic, hence their propensity to malignancy. Ovarian malignancies also tend to have attachment to contiguous structures which provides additional support making them unlikely to twist.

The large sizes of the tumors may affect the choice of laparotomy versus laparoscopy.[15],[16] Skill of the attendant surgeon with regards the aforementioned techniques are issues that need to be considered in the setting where training in interventional laparoscopy is low.[15],[16] In our environment, the skill in operational/interventional laparoscopy is low compared to advanced countries.[15],[16] It will, however, have the advantage of reduced hospital stay, cosmesis, and probably improved patient satisfaction. In the absence of such skill, it is safer to go through the approach of open surgery as against port surgery as this has the advantage of good accessibility. This also makes for satisfactory exploration of the intra-abdominal and pelvic organs.

The role of detorsion as some experts have suggested was not considered in these cases as it is often our practice not to untwist twisted ovarian cysts for the fear of reperfusion injuries and releasing emboli and toxins into the systemic circulation. However, this technique may be considered in patients who have subfertility [4] and who for one reason or the other have the need to preserve a functional ovary for future fertility desires. In places where facilities for ovum harvest and freezing are available, the diseased ovary can be surgically removed provided good ova have been harvested for this purpose.

The role of histological diagnosis also cannot be overemphasized as the need to rule out malignancy is paramount.[10] From previous studies, it is evident that most ovarian cysts in the reproductive age group are benign.[2],[5],[8] Although all the cases reviewed were benign, it is still important in patient-counseling and subsequent follow-up appointments.

Limitations

It is pertinent to note that though this was an 8-year review, the data seem to be scanty making extensive statistical analysis difficult for the following reasons:

  • The rarity of the condition described as seen from previous studies where the incidence of ovarian cyst accidents is ≤10%[3],[5],[6]
  • ABUTH, being a referral center, other cases might have been “filtered” at lower levels of health care such as general and private hospitals in the state
  • The frequent strikes and industrial actions that occurred in the period.



  Conclusion Top


Most of the cases of ovarian cyst accidents were in the reproductive age group, in multiparous women, benign on histology and were not long-standing sufficiently to alter blood parameters such as the hematocrit and blood chemistry as they presented early due to the acute nature of manifestation. Acquisition of requisite skill by surgeons in operative laparoscopy will be beneficial to some selected patients as this may improve cosmetic and reduce hospital stay.

Acknowledgment

The staff of the Records Department and Pathology Department of Ahmadu Bello University Teaching Hospital, Zaria, is acknowledged for their role in retrieval of case notes and results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kolawole AO, Ogbe MA, Samaila MO. Huge mucinous cystadenoma presenting as an acute abdomen in the puerperium. West Indian Med J 2012;61:646-7.  Back to cited text no. 1
    
2.
Fawole A, Awonuga D. Gynaecological emergencies in the tropics: Recent advances in management. Ann Ib Postgrad Med 2007;5:12-20.  Back to cited text no. 2
    
3.
Becker JH, de Graaff J, Vos MC. Torsion of the ovary: A known but frequently missed diagnosis. Eur J Emerg Med 2009;16:124-6.  Back to cited text no. 3
    
4.
Oelsner G, Shashar D. Adnexal torsion. Clin Obstet Gynaecol 2006;49:456-63.  Back to cited text no. 4
    
5.
Buowari DY. Ovarian cyst at general hospital, Aliero, Nigeria: A one-year review. Trop J Med Res 2009;13:433-4.  Back to cited text no. 5
    
6.
Cengiz H, Kaya C, Ekin M, Yesil A, Yasar L. Management of incidental adnexal masses on caesarean section. Niger Med J 2012;53:132-4.  Back to cited text no. 6
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Ikechebelu JI. Prevalence of gynaecological diseases in Nnewi, Nigeria. Niger J Clin Pract 2005;8:136-7.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Rofe G, Auslender R, Dirnfeld M. Benign ovarian cysts in reproductive age women undergoing assisted reproductive technology treatment. Open J Obstet Gynaecol 2013;3:17-22.  Back to cited text no. 8
    
9.
Jones KD. The prevalence and age distribution of ovarian cysts among women attending a London teaching hospital. J Obstet Gynaecol 2001;21:70-1.  Back to cited text no. 9
    
10.
Forae GD, Aligbe JU. A histopathological overview of ovarian lesions in Benin city, Nigeria: How common are the functional cysts? Int J Med Public Health 2014;4:265-8.  Back to cited text no. 10
  Medknow Journal  
11.
Buowari Y. Right sided mucinous cystadenoma in a 19 year old Nigerian nullipara: A case report. Internet J Fam Pract 2009;9:1-4.  Back to cited text no. 11
    
12.
Abduljabbar HS, Bukhari YA, Al Hachim EG, Alshour GS, Amer AA, Shaikhoon MM, et al. Review of 244 cases of ovarian cysts. Saudi Med J 2015;36:834-8.  Back to cited text no. 12
    
13.
Lim S, Lee KB, Chon SJ, Park CY. Is tumor size the limiting factor in a laparoscopic management for large ovarian cysts? Arch Gynecol Obstet 2012;286:1227-32.  Back to cited text no. 13
    
14.
Samsad J, Nusrat M, Samiron KM, Tripti D, Nargis A, Samsun N, et al. Laparoscopic surgery for large benign ovarian cysts: Experience in a tertiary care hospital in Bangledesh. J Gynaecol Surg 2011;27:83-6.  Back to cited text no. 14
    
15.
Nowak M, Szpakowski M, Malinowski A, Maciolek-Blewniewska G, Wilczynski JR, Wladzinski J, et al. Laparoscopy and laparotomy in the operative treatment of ovarian cysts. Ginekol Pol 2000;71:1173-8.  Back to cited text no. 15
    
16.
Eltabbakh GH, Charboneau AM, Eltabbakh NG. Laparoscopic surgery for large benign ovarian cysts. Gynecol Oncol 2008;108:72-6.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2]



 

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