Diagnosis of a Ruptured Ovarian Cyst
There are many diagnostic tests that your gynecologist or emergency physician has available to confirm the diagnosis of a ruptured ovarian cyst. Many of these tests are similar to those which would be used to confirm an intact ovarian cyst. If you have presented to an emergency department in a critical condition, your medical team will first act to stabilize you as they work to make the diagnosis of ruptured ovarian cyst. The diagnosis will proceed more smoothly and routinely if you have presented in a more stable condition.
Regardless of your presentation, your doctor will want to run a complete blood test. This test has several components, which will tell the doctor more about your condition. Your doctor will want to examine your hematocrit level. This measure is an indication of how much of your blood volume is occupied by red blood cells. Decreased hematocrit is indicative of anemia, which may be associated with internal bleeding. Your doctor may also examine your hemoglobin level, which in the case of hemorrhage may be close to normal, or slightly lower.
Your doctor will also examine your white blood count (WBC). White blood cells are involved in defending your body against infection. If you have an uncomplicated cyst or irregular menstrual cycles, your white blood cell count may be normal, or only slightly elevated. Excessive elevation of the white blood count, also known as leukocytosis, is indicative of bacterial infection, trauma or stress. Other blood properties, such as prothrombin time, activated partial thromboplastin time and international normalised ratio, will be measured to ensure that your blood is capable of clotting normally. Your doctor may also order a CA 125 antigen test, which will indicate conditions such as endometriosis, pelvic inflammatory disease or a malignant ovarian cyst. This test takes 24 hours to produce a result, so it will rarely be undertaken in an emergency situation.
It will also be important for your doctor to test for pregnancy. The symptoms of a pregnancy in the fallopian tubes, known as an ectopic pregnancy, are very similar to those of a ruptured ovarian cyst. The presence of human chorionic growth hormone (hCG) in your blood will confirm a pregnancy. Your doctor will also want to undertake an analysis of your urine. Urine which contains pus or blood may be indicative of an inflamed or infected ovarian process, such as a ruptured ovarian cyst.
Imaging studies will also be used to help your diagnosis. In particular, ultrasounds are very useful in making the diagnosis of an ovarian cyst. These can be used to assess the size of an ovarian cyst, its structure and complexity (whether it is simple or complex). Ultrasonography will also allow your doctor to confirm a pregnancy. Certain types of ultrasound can be used to assess blood flow to the ovary. Lack of flow may indicate that your ovaries have become twisted due to the size and location of your cyst. If ultrasound imaging does not assist your doctor’s diagnosis, then a computerized tomography (CT) scan may be used.
If your doctor does not have access to ultrasonography or if your condition is very unstable, culdocentesis may be performed. During this procedure, a needle is inserted into the abdomen to test for the presence of fluid within the abdomen. The presence of fluid indicates a ruptured ovarian cyst, inflammation of the liver or carcinoma.
In certain conditions, your doctor will perform a laparoscopy as part of the diagnostic process. During this procedure, a small incision is made in your belly, near your belly button. A small camera can be inserted through this incision and your internal organs can be directly inspected. If necessary, surgical procedures, such as the removal of an ovarian cyst or your ovaries, can be conducted using a laparoscopy.
Throughout the diagnosis, it will be your medical team’s aim to rapidly determine if your cyst has ruptured and the extent and consequences of the rupture. Having your abdominal pain investigated early means that the chances of complications are less.