When large ovarian cysts pose problems in removal by laparotomy, the only alternative left is to drain out their contents, so that they may get a chance to shrink to a manageable size. Though such instances are rather rare now since ovarian cysts are diagnosed at an early stage through ultrasound, laparoscopic examination, CT scan, Magnetic Resonance, etc and taken care of, some cases do occur still when such steps become necessary. A case of ovarian cyst drainage that created uproar in the medical profession around a year ago concerned a 37 year old lady, diagnosed with a 328 lb mucinous cystadonema in her abdomen.
Another incident of ovarian cyst drainage and drew attention recently involved a woman aged 50 years who had progressive abdominal distension for a period of 3 years. She weighed 73.5 kg and her abdominal girth was at 145 cm. She walked with a limp, no doubt caused by the enormous tummy. An ultrasound exam affirmed that there was an enormous cystic mass in the pelvic area. Biochemical and hematological investigations confirmed mild hypochromic microcystic anaemia, PCV of 30, BUM, liver function, serum electrolytes, blood sugar, RCG, blood gases from the arteries proved within normal limits.
Before any major step could be taken, it was determined that the cyst should first be drained and accordingly the same was done in stages for 14 days; 12.5. liters was tapped by carrying out paracentesis repeatedly every two to three days, removing around 3 liters per day, over 6 to 12 hours. On the 15th day, the lady's preoperative girth in the abdomen decreased to just 121 cm and her weight came down to 63 kg.
No sedative pre-medication was prescribed before the actual surgery while the atropine injection 0.5 was given intra muscularly. To replace the fluid the peripheral intravenous line and central venous was injected. Suxamethonium (75 mg), thiopentone (125 mg) and anesthesia was applied intravenously. The pressure of Cricoid was also applied immediately before induction. The No.7 oral cuffed endotracheal tube was used to intubate the patient. Controlled ventilation with nitrous oxide at 70% and controlled ventilation was applied to maintain the patient. Injection pancuronium 4 mg assured muscle relaxation while the nasogastric tube passed through. And finally, Diazepam 2.5 mg and Pentazocine 10 mg was administered intravenously.
Intraoperatively the patient was given 3 units of blood and 2 liters of crystallids and a multilocular mucinous cyst was taken out, and this had greenish and vicious fluid of 22.5 liters. CVP (central vevenous pressure) was kept between three to five cm of the urine and H20 output when the surgery was over was at 1200 ml. Prostigmine (2.5 mg) and atropine (1mg) was reversed on the patient intravenously. She was extubated on the table and was found to be breathing well, and later was returned to the intensive therapy section for postoperative treatment and care.
The holistic approach has become popular in recent years as a cure for many diseases including ovarian cysts. 'Holism' has been linked to maintaining good health for years now, but it has been integrated with the mainstream 'Health care system' is a recent development. The fact is, the holistic approach cures cysts in the ovary completely, and it also prevents its occurring through altered diet, healthy habits and change of lifestyle. Holistic method is not merely a technique adopted in curing a disease condition; it is an ideal concept for doing so, involving a mighty lot of factors that govern our bodily functions.