A HUGE OVARIAN CYST.

% Asst. Surgn. Rai Sahib CHHAGAN NATH,

Officiating Residency Surgeon, Mcwar, Udaipur.

Cases of ovarian cysts, though not very

com-

in this part of the country, are

met with now

an(1 again in hospital practice. The Patl<r"

Usually presents herself with a considera c

abdominal enlargement, as admission to a hospita

ls ^nly sought when all sorts of quack

remedies,

P?tion for ascites, and even waiting tor

r>regnancy prove futile. j

J The following is the history of

the case

Fnt i! ' fcmalc> aKcd 40- marricd' nuT11,par,a* no Hns

Pi?a? lyTT^?war- was admittcd t0,thC k"S 1Q28 She

no? ' ,Uda,W, on the 14th September, 1928 bhe

abdn gradual enlargement on the left sideof I e

which {or th^ last twQ yearS had become

very

and inlnt-, The abdomen had a spherical

costai rd lump was felt on the

left side, .

for 1 ma,;Rin-. the lump could easily have

been mistaken

n enlarged spleen.

incViPe c'rcumference round her umbilicus was

> and the measurement from the ensiform

cartilage

to the symphisis pubis 20i inches. She had an emaciated look. Her urine was normal. On internal examination there was no abnormality of the uterus. Her menstrual periods were normal and regular.

Operation.?After thorough preparation, the patient was placed on the operation table, and an incision of about 4 inches was made in the median line below the umbilicus. After separation of the skin and recti, the peritoneal coat was divided. The anterior aspect of the

cyst-wall was then surveyed with the hand.

On searching for adhesions the omentum was found at some ̂ places sticking to the sac and could not be removed. A small band was found on the left side, which was ligated and snipped. A Spencer-Wells' ovariotomy trocar was then plunged into the cyst-wall, and the fluid evacuated, but the evacuation was not as

much as expected, as another big cyst was found inside it. This was also punctured and evacuated through the main cyst, care being taken that no fluid contents entered the abdominal cavity.

Description of the cysts.?The sac was then gradually pulled through the opening, the pedicle securely tied and cut. The pelvic cavity and the walls were sponged dry. The abdominal wound was sutured in the usual way.

On examining the sac, six more daughter cysts were found in it, containing fluid of different colour and

consistency. The fluid in the main cyst was of a dark brown colour containing a degenerated cheesy mass, three contained clear ropy fluid, like saliva, two had sebaceous matter, one contained fluid like bile, and the one which was in the splenic region contained a tuft of hair and a rudimentary tooth.

Weight of the fluid was 31 lbs., 4 ozs. Weight of the sac was 3 lbs., 1 oz.

Weight of the hair and tooth 5 drs.

V0 |??TWy^-

$gM55EE?B!

258 THE INDIAN MEDICAL GAZETTE. [May, 1929.

Making a total weight of the cyst equal to 34 lbs., 5 ozs. 5 drs.

The sutures were removed on the tenth day, the wound healed by first intention, and the patient made a rapid recovery. After operation she developed a voracious appetite, but this had to be controlled. Three weeks after the operation she was allowed to go home, as she

was very desirous to celebrate the dhascra festival at her own home as a

' new' woman.

My thanks are due to Dr. Sunder Lall, m.b., b.s., for his assistance.

Summary.

The interesting- features of this case are:?

(1) The huge enlargement of the abdomen, with a comparatively short history of two years.

(2) The solid feel of the lump on the left side resembling an enlarged spleen.

(3) The presence of a cyst inside a cyst; and the other half a dozen cysts each containing a

different kind of fluid.

(4) Iier great desire for food soon after the operation.

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