How is an ovarian cyst rupture diagnosed?

Updated: Dec 20, 2018
  • Author: Charles Nathan Webb, MD, MS; Chief Editor: Nicole W Karjane, MD  more...
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Answer

Perform a urine pregnancy test. If the pregnancy test is positive, make sure to rule out an ectopic pregnancy. Evaluate for ovarian torsion before discharge. If a diagnosis of bleeding ruptured ovarian cyst is considered, make sure the hemoglobin level is stable before discharging the patient. It is appropriate to admit the patient for observation and pain control.

Perform a diagnostic laparoscopy and/or laparotomy if the patient is hemodynamically unstable or if a specific diagnosis is unclear, yet a definitive diagnosis is necessary.

A study by Shiota et al indicated that C-reactive protein (CRP) levels can be used preoperatively to differentiate a ruptured ovarian cyst from ovarian torsion. In a retrospective evaluation of 98 patients diagnosed with a benign ovarian cyst, it was found that 21 patients with a ruptured cyst and 77 patients with ovarian torsion had mean preoperative CRP levels of 6.6 and 0.9 mg/dL, respectively; the mean size of the ovarian cysts also differed significantly between the two groups (6.7 cm and 9.7 cm, respectively). The investigators mentioned another study, however, that indicated that patients with ovarian torsion who present over 10 hours after the onset of acute abdomen with elevated CRP levels are at risk of necrosis. They suggested, therefore, that by taking into account imaging findings, CRP levels, and time of acute abdomen onset, clinicians can preoperatively differentiate ovarian cyst rupture from ovarian torsion. [8]

Tanaka et al suggest that plasma D-dimer levels may be markers for endometriotic ovarian cyst rupture. [9] In their study of 6 patients with emergent endometriotic cyst rupture and 16 control patients with unruptured endometriotic cysts, significantly elevated plasma D-dimer levels were seen in the group with the ruptured cysts. The investigators also noted that differences in white blood cell count and serum CRP levels between the two groups were statistically significant. [9]


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