A case of ovarian cyst with partial torsion in an adolescent girl

Gracelin Jebamalar1, Girija2, Arputhamary3

1Senior staff nurse, Kauvery hospital, Tennur, Trichy, Tamil Nadu

2Nursing In charge, Kauvery hospital, Tennur, Trichy, Tamil Nadu

3Assistant nursing superintendent, Tennur, Trichy, Tamil Nadu

Abstract

Ovarian cysts are uncommon in adolescents compared to reproductive-age women. They may be present with abdominal pain, fever, or acute complications like torsion or rupture. This case highlights the diagnostic and management challenges of recurrent ovarian cysts in an adolescent, emphasizing the importance of imaging and multidisciplinary care.

Introduction

Ovarian cysts are fluid-filled sacs that develop within or on the surface of the ovary. Although frequently observed in women of reproductive age, their occurrence in adolescents is relatively rare. Larger cysts may lead to abdominal pain, torsion or infection, requiring prompt medical or surgical management. Early diagnosis and multidisciplinary coordination are vital for achieving favorable outcomes and preserving ovarian function.

Case Presentation

A 14-year-old girl was admitted with complaints of right loin pain and intermittent fever for ten days. She had previously been evaluated at an external center for similar complaints one month earlier. Ultrasound and MRI revealed a right ovarian cyst, for which she underwent a right-sided ovarian cystectomy in June 2025.Following surgery, the patient was referred to our hospital in August 2025 for further management due to persistent abdominal pain. On evaluation, initial clinical assessment was done, and an MRI of the pelvis was advised.

The imaging revealed a large cystic lesion located in the midline above the bladder and uterus, suggestive of a benign simple ovarian cyst. The right ovary could not be visualized separately, and the possibility of torsion could not be excluded. A hemorrhagic cyst was also noted in the left ovary, with minimal free fluid in the pelvic cavity.

CECT Abdomen and Pelvis

Contrast-enhanced CT revealed a large, well-defined, partially peripherally enhancing hypodense cystic lesion with internal septations, causing mild right hydroureteronephrosis, findings suggestive of a hemorrhagic cyst or abscess.

Management and Surgical Intervention

The case was reviewed by an oncosurgeon. Based on clinical and imaging findings, a laparoscopic right ovarian cystectomy with abscess drainage was planned and performed for a recurrent ovarian cyst with partial torsion. The patient remained hemodynamically stable throughout the procedure. Biopsy samples were sent for histopathological evaluation to confirm the diagnosis.

Histopathology Report

Histopathological examination showed no evidence of malignancy.

Hematological evaluation revealed dimorphic anemia, likely secondary to iron and vitamin B12 deficiency

Postoperative Care

Postoperatively, the patient experienced mild surgical site pain. Intravenous fluids were discontinued, and she was advised to resume a normal diet. She was educated to avoid heavy lifting and maintain good personal hygiene. Laxatives were prescribed to prevent constipation.

General Condition at Discharge

  • Temperature: Afebrile
  • Pulse Rate: 86/min
  • Respiratory Rate: 22/min
  • SpO₂: 99% (room air)
  • Blood Pressure: 90/60 mmHg

Treatment Plan at Discharge

Further management was advised based on histopathology results.

Medications Prescribed

  • Augmentin 625 mg – 1 tablet three times daily for 1 week
  • Pantocid 40 mg – 1-0-0 for 1 week
  • Cremaffin Plus 15 ml – 0-0-1 for 1 week

Nursing Responsibilities

  • The nurse monitored the patient’s vital signs regularly to detect early complications.
  • Strict aseptic technique was maintained during IV medication administration and wound care.
  • Pain levels were assessed frequently using a numerical rating scale, and prescribed analgesics were administered accordingly.
  • The nurse observed signs of infection, such as fever or wound discharge, and reported promptly.
  • Intake and output were closely monitored to ensure adequate hydration.
  • Health education was provided regarding diet, rest, and activity restrictions following surgery.
  • The patient and her parents were educated on medication compliance and the importance of follow-up visits.
  • Emotional support was provided to reduce anxiety related to surgery and recovery.

Health Promotion

  • The patient was advised to avoid junk food and maintain a balanced, nutritious diet.
  • She was encouraged to attend regular follow-up visits for gynecological evaluation.
  • Counseling was provided to promote healthy lifestyle practices and prevent recurrence.

Conclusion

Nursing care played a crucial role in postoperative recovery, infection control, and patient education, ensuring a smooth transition from hospital to home care. The patient had discharged with stable condition and explained follow up medication and visits.

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