Complications
One study reported spillage of the cyst contents in 18% of cases in a laparoscopy-managed group and 1% in a laparotomy-managed group of women with dermoids. However, no increase in morbidity was noted.[73] Some cysts do carry a malignant potential, and the risk of peritoneal implantation of squamous cell carcinoma following cyst rupture is recognized. Such risk prompts many gynecologic oncologists to recommend laparotomy over laparoscopy for management.[2]
A catastrophic intraperitoneal bleed may result from rupture of a corpus luteum cyst, specifically among patients on anticoagulants or with bleeding disorders. Such rupture often follows sexual intercourse, exercise, or pelvic examination. This often occurs between days 20 and 26 of a normal menstrual cycle.[6] Dermoid cysts may also rupture, releasing contents and triggering an inflammatory cascade that often results in peritonitis. This is a rare complication, but it must be heeded during laparoscopic and open surgical removal.
A retrospective study revealed a torsion rate of 14.8% of surgically treated adnexal masses.[82][83] Whereas the classic symptoms of abdominal pain and fever have been described, diagnosis was accurate at first clinical examination in only 57.8% of cases. Resolution via laparoscopy was successfully achieved in 34% of patients. Conservative management was used in 57% of the premenopausal patients. No major postoperative complication was noted.[82] Ovarian necrosis is a complication of torsion.
The rates of cyst torsion in pregnancy have been upward of 30%; however, some studies demonstrate much lower rates (1% to 7%).[14][77]
Cervical motion tenderness and pain on intercourse is more commonly associated with pelvic inflammatory disease, but can be a presenting symptom of ovarian cyst.
The potential of a benign ovarian cyst becoming malignant has not been proved, but malignant change may occur in a small percentage of endometriomas.[20]
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