While a definitive diagnosis of ruptured ovarian cyst is typically made at the time of surgical evaluation, a presumed diagnosis of cyst rupture can be made in a patient with symptoms consistent with this condition (eg, sudden onset of unilateral, lower abdominal pain, often following sexual intercourse or exercise), and with transvaginal ultrasound findings of an ovarian cyst plus blood or a large amount of serous fluid in the pelvis.Pregnant patients, patients with a bleeding diathesis, or those with a ruptured teratoma or endometrioma may be managed differently; this is discussed in related UpToDate topics.
STI: sexually transmitted infection; TOA: tubo-ovarian abscess.
* Large volume of hemoperitoneum, 10-point drop in hematocrit (or less if the original hematocrit is already low).
¶ Repeat transvaginal ultrasound to evaluate for an increased volume of intraperitoneal blood is performed when there is uncertainty if bleeding is ongoing.
Δ Evaluation may include cervical cultures, tumor markers, further imaging with computed tomography (appendicitis) or magnetic resonance imaging (ovarian cancer). This is discussed in related UpToDate topics.◊ Patients with uncomplicated cyst rupture have an ovarian cyst that bleeds a small or moderate amount, the bleeding is self-limited, and are without a significant drop in hematocrit.
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