Surgeon explains real reason 38 year old woman suffered from severe period pain, painful sex before difficult surgery

To treat her condition, a team of surgeons performed a complex laparoscopic cystectomy, carefully removing the cyst without damaging nearby tissues.

In an interview with HT Lifestyle, Dr Arpit Bansal, a laparoscopic surgeon and oncologist at Jeevan Jyoti Hospital, Prayagraj, shared a detailed account of a medical case involving a 38-year-old woman with a massive ovarian endometrioma, also known as a 'chocolate cyst'.

The doctor shared that the surgery involved careful planning, advanced tools, and a stepwise approach to avoid damaging nearby tissues or spilling the cyst's contents. (Representative picture: Freepik)

Signs of advanced endometriosis

The cyst was approximately 15 cm in size and caused severe pelvic pain, painful sex, and infertility, he said, and added that this rare and large cyst filled her entire pelvic cavity, causing pressure on surrounding organs and dramatic symptoms. Sharing details, Dr Bansal said, “A woman aged 38 came in with severe pelvic pain, painful sex, and infertility – all traditional signs of advanced endometriosis. She had endured the discomfort for years, with frightful pain during menstruation and even mundane acts such as intimacy or defecation.”

“An ultrasound and CT scan ultimately determined the cause: a huge ovarian endometrioma (a cystic growth of endometriosis commonly referred to as a 'chocolate cyst') approximately 15 cm in size, taking up nearly her entire pelvic cavity. Endometriosis is a surprisingly prevalent gynecologic ailment – occurring in approximately 10 percent of women of reproductive age across the globe – and is linked to debilitating, life-altering pain and frequently infertility,” he added.

In this patient's situation, Dr Bansal explained the enormity of the endometrioma was unusually large and was to blame for her severe symptoms: persistent pelvic pressure, bouts of constipation, and incessant pain that dramatically affected her quality of life. He said, “Large ovarian endometriomas are rare and can exert extreme pressure on surrounding organs, which is why the patient is having pain and gastrointestinal symptoms. The patient usually needs surgery for symptomatic relief in these situations.”

A conservative but difficult surgery

To treat her condition, surgeons performed a complex laparoscopic cystectomy, carefully removing the cyst without damaging nearby tissues or spilling its contents. The surgery involved meticulous planning, advanced tools, and a stepwise approach. After aspirating the cyst's thick liquid, the team successfully removed it, relieving the patient's symptoms.

Dr Bansal said, “Considering the patient's age and the wish for fertility, her physicians decided on a conservative but difficult surgery: laparoscopic cystectomy to remove the endometrioma without sacrificing normal ovarian tissue. It is technically demanding to do minimally invasive laparoscopic surgery on a 15 cm cyst. The team meticulously planned the operation. The major challenges were to be expected: restricted working area, danger of damaging neighboring organs (bowel, bladder), and the paramount importance of avoiding spillage of contents of the cyst.”

He added, “During surgery, the giant cyst had become adherent to some of the bowel and omentum. Cautious dissection was carried out with the cyst intact. After it was isolated, the team cut a small window in the cyst wall and placed a suction cannula to suck out the thick 'chocolate' liquid, thereby deflating the cyst and preventing spillage. This brilliant maneuver reduced the size of the cyst sufficiently to allow visibility and working space to return. The team was then able to carefully strip off the cyst capsule from the ovary. They managed to entirely remove the endometrioma laparoscopically, without any conversion to open surgery.”

According to Dr Bansal, the biggest challenge was the size of the cyst and adhesions to the essential structures: “The patient's bowels were plicated, resulting in constipation. Adhesions rendered anatomy challenging to maneuver. The team addressed this through the use of advanced laparoscopic tools and the stepwise method. Aspiration of the cyst internally prior to removal was crucial to safety.”

How is the patient now?

The woman recovered quickly, with her pain and bowel function improving significantly. This case showcases how advanced laparoscopic surgery can effectively treat large endometriomas, improving patients' quality of life.

Dr Bansal said, “The patient recovered quite well. Due to the minimally invasive technique, she was ambulatory within a day and discharged in two days. Her painful intercourse and pelvic pressure disappeared, and her bowel function returned to normal. Pathology revealed a benign endometriotic cyst. Postoperative hormonal therapy was initiated to avoid recurrence. The case highlights how cutting-edge laparoscopic surgery can tackle even giant endometriomas, offering patients relief from a debilitating condition and improving their quality of life.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.