Page 46 - World Journal of Laparoscopic Surgery

Multiple and Bilobed Ovarian Dermoid Cysts

Fig. 1: CT scan showing bilateral adnexal cysts with mixed echogenicity

Fig. 2: Left ovary appearing collapsed after first dermoid cyst removal, Fig. 3: Right ovary twisted, bilobed dermoid cyst
posteriorly, second dermoid cyst visible
• Left ovary enlarged up to 9 × 9 cm appearing as one big ovarian
right adnexa suggestive of torsion. Uterus was normal size. No free cyst.
fluid in the pelvis was noted. • Left fallopian tube normal.
Multidimensional CT of pelvis with contrast confirmed the • No adhesions.
ultrasound findings (Fig. 1). • Intact capsule.
Management Plan The presence of two dermoid cysts co-inhabiting in left ovary
Bilateral laparoscopic cystectomy SOS ovariotomy was planned for could not be differentiated until the proximal one was removed.
Complete cystectomy of both dermoid cysts (4 × 4 cm and
this patient under general anesthesia. 5 × 5 cm respectively) from the left ovary was carried out, and
Laparoscopic Findings (Figs 2 and 3) hemostasis was checked in the remaining normal ovarian tissue
on the left side.
• Bilateral smooth ovarian cysts The dilemma was whether or not to remove the ovary on
• Right cyst bilobed and ischemic, each measuring 4 × 4 cm. the right side along with the dermoid cyst. After a considerable
• Right Fallopian tube engorged and twisted along with the discussion, the decision of right-sided ovariotomy with right-sided
bilobed ovarian cyst by 2 turns. salpingectomy was taken and proceeded.

44 World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020)