Giant ovarian cyst in a woman in rural Africa
© Springer-Verlag 2007
Received: 7 June 2007
Accepted: 5 July 2007
Published: 15 August 2007
A 42-year-old woman presented to the open access surgical outpatients clinic run by an international Non-Governmental Organisation in the south western region of Chad in central Africa. She gave a 2-year history of increasing abdominal girth, which had recently been associated with breathlessness and lower back pain. This had forced her to stop work, culminating in her self-referral to the clinic. In the absence of access to helpful investigatory modality, we performed an exploratory laparotomy, during which a large cyst (15.1 kg, 12.5 l) in the left ovary was excised and abdominoplasty was performed. She made a good recovery with no complications and was discharged 5 days postoperatively.
Modern treatment of giant ovarian cysts involves blood tests, such as those for tumour markers (e.g. CA 125), and imaging before surgical excision. The intervention can be performed laparoscopically after drainage of the cyst either pre-operatively under imaging guidance  or per-operatively via the laparoscope port , supra-pubic catheter  or a mini-laparotomy . This case report presents the management and findings of a giant ovarian cyst in a woman in rural Africa, in an environment with limited access to haematological and imaging investigations.
A 42-year-old multiparous woman presented herself to the open access surgical outpatients clinic in the south western region of Chad. Via a translator, it became apparent that she had noted a gradual swelling of her abdomen over the preceding 2 years. She had originally felt that this might have been a pregnancy; however, her menstrual cycle had continued normally and she had failed to recognise all other systemic changes that she had noted in her previous pregnancies. As she had no other symptoms that would have stopped her work as a farmer and housewife, she had ignored the swelling. She had continued her work in the field (crop farming), but recently had found this increasingly difficult due to shortness of breath and lower back pain. She was otherwise fit and well and had no previous medical history of note.
In view of these findings a presumptive diagnosis of giant ovarian cyst was made, but, in the environment in which she presented, a definitive pre-operative diagnosis was not possible. There was no easy access to any form of radiological imaging, and the haematological investigations available consisted of full blood cell count, which was within normal limits. As she was significantly limited in her daily undertakings by this pathological condition, it was decided to proceed to an explorative laparotomy.
Within the realms of modern medicine, giant ovarian cyst are rare, as they are normally diagnosed and treated relatively early in their development. However, when present, they are investigated by imaging and tumour markers (CA 125) and can then be excised laparoscopically after drainage of the cyst [1–5].
In the third world, where survival is often determined by access to food and presence of politically mediated violence, the patients tend to ignore asymptomatic pathological conditions such as those described here until there is an impact on essential daily chores pertinent to survival. In this case, laparotomy also afforded the added luxury of an extensive abdominoplasty, which is not performed as part of a laparoscopic procedure.
Although some believe modern medicine to be over-dependant on modern techniques and imaging investigations, in the absence of such tests definitive diagnosis is possible only by an exploratory laparotomy, perhaps better classed as an investigation with therapeutic possibility, in settings such as described here.
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