Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
185 Doctors are Online

Treated for ectopic pregnancy. Lower abdominal pain. TVS ultrasound showed hemorrhagic cyst. Prognosis?

Apr 2013
User rating for this question
Very Good
Answered by

General Surgeon
Practicing since : 2008
Answered : 9335 Questions
TVS ultrasound done today after intermittent pain in lower left side of abdomen for past six months (ectopic pregnancy treated with single dose of biotrexate injection in october 2012 and in between visisted several doctors who described the pain as infection, irritable bowel syndrome on several blood reports and ultrasound etc.) has shown rt adnexa e/o cystic area of size approx. 32x30mm with fine separations seen in rt. adnexa s/o? haemorhagic cyst.
please advise i am patient's husband and very distressed for past six months.
Posted Sat, 27 Apr 2013 in Abdominal Pain
Answered by Dr. Ivan R. Rommstein 1 hour later
Hi and welcome to XXXXXXX Thank you for your querry.
Ovarian cysts are very common in woman's childbearing years. These are benign in more than 95% and not harmful except in rare cases.
Haemorhagic cyst is folicular cyst which develops when blood accumulates in simple follicular cyst. Cyst development is related to slight possibility of ectopic pregnancy. Generally, cysts in younger women tend to resolve themselves with monthly ovulation. Considering this report this is benign, noncomplicated cyst.

It can be asymptomatic, but usual symptoms are irregular periods, lower pelvic pain and pain during intercourse and vaginal bleeding.
3cm cyst is moderately large cyst and it can be a reason for her intermittent pain. It can grow even to 8-10cm. It would cause severe pain if become torsioned or ruptured.

Doctors recommend that cyst should be removed if larger than 5cm, press surrounding organs,show abnormal and fast grow or cause persistent pain.

Usually,in the beginning doctors prescribe birth control pills to control hemorrhagic cysts. If the pain persists after this, ultrasounds should be repeated after 2 months and if it shows size progression, doctor may suggest cyst removal which done laparoscopicaly today and it is pretty simple procedure.

All in all, this cyst is probably the cause of her symptoms,but there are some other possible causes such as endometriosis, pelvic infection(std, tuboovaran abscess etc.) or diverticulitis and other bowel issues. But I suggest to go step by step and first evaluate her reproductive system, do MRI if necessary or diagnostic laparoscopy. Nothing bad can happen in short time.Ask your doctor about hormonal therapy and some stronger pain killers. I am sure she will feel better.
Hope I have answered your query. If you have any further questions I will be happy to help"
Above answer was peer-reviewed by
Follow-up: Treated for ectopic pregnancy. Lower abdominal pain. TVS ultrasound showed hemorrhagic cyst. Prognosis? 53 minutes later
cyst is diagnosed in today's ultrasound, but in last ultrasound performed on 7 december 2012 no parametrial mass lession was seen, also minimal fluid is seen in pod in both reports. However, what concerns is pain is below left pelvic (AROUND AND BELOW WAIST) region and its back which spreads to thighs and also felt in vaginal muscles as felt by the patient and cyst is found in rt adnexa. yesterday she had bad stomache and two vomitting. Also noticed in past 3 months is pain is more between 5th to 25th of month and her period falls on 14-15 of a month. patient has consulted 3-4 doctors at least 10 times in all and has undergone many blood test (CBC, TSH, VIT B 12, FOLIC ACID), urine test, vaginal inspection, stool test etc. with nothing found in them except e coli(normal flora) in stool test, but ecoli o157:h7 was not found. Last doctor reported to, after two consultation and many blood, stool, urine test had attributed pain to placentrex injection which was not taken as too many injection while treatment to ectopic was taken. MOST OF PAIN IS FELT IN LEFT SIDE AROUND WAIST AREA, DIGESTION IS MOSTLY GOOD 2-3 TIMES A DAY. I have tried to provide as much information. SIR please give good thought to the problem and advise. thanks.
Answered by Dr. Ivan R. Rommstein 33 minutes later
Hi again. It doesnt matter if pain is on the left side and cyst on the right. It can be caused by the cyst because this is combination of visceral and parietal pain which usually gives refered pain felt in perineal area and thighs. Cyst can be infected or can cause minor bleeding after rupture; this leads to fluit collection in XXXXXXX pouch and after this pain can be felt all around pelvis.
Also there might be pelvic abscessus or residue after ectopic pregnancy and if she experience pain periodically this is a sign of possible endometriosis.
ALl these things I am mentioning cannot be verified by blood test, ultrasounds or vaginal examination. Some more sophisticated methods such MRI, CT or diagnostic laparoscopy are necessary for detailed visualization. I suggest to do it if you dont believe this is IBD, and I dont believe it either.
It can be related to colon, but it is more likely diverticulits or colon endometriosis. This is all I can tell you without knowing her findings and without further tests noone cant tell you the right diagnosis.
Above answer was peer-reviewed by
Follow-up: Treated for ectopic pregnancy. Lower abdominal pain. TVS ultrasound showed hemorrhagic cyst. Prognosis? 28 minutes later
Thank you sir, my question is what should be next course of action, to consult a doctor I should visit whom physician or gynecologist or surgeon (doctor who treated her for ectopic was surgeon), till now i was consulting gynae doctor. also MRI or dianostoctic lapsocoply or ct scan which should be better. What tests should she undergo for right diagnosis.
Answered by Dr. Ivan R. Rommstein 29 minutes later
Usually gynecologist should recomment these tests.I dont know will he find enough indications for it,but persistant pain should be something for further evaluation.
MRI and CT are less invasive than laparoscopy. I dont know how hard is in your country to get these tests. But usually CT should be the first and the easiest option,there is some irradiation,but isnt harmful if CT isnt oftenly performed. MRI is more sophisticated and there is no irradiation but it is more expensive too.
CT can visualize her digestive and reproductive organs and fluid collections.
If it shows no abnormality then there is nothing to worry.
But I dont think her condition is something serious. SUch difficulties are experienced by many women and usually treated by hormonal therapy and painkillers and antibiotics if suspected infection.
Above answer was peer-reviewed by
Share on Facebook
Share on Twitter
Share on Google+
Question is related to

The user accepted the expert's answer

Ask a Gastroenterologist

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor