(Ruptured ectopic gestation is a close D/D)
An exploratory laparotomy showed ruptured corpus luteal cyst, with active ooze from the cyst, which was sutured.
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Graafian follicle cyst
most common type of ovarian cyst
forms when mature follicle fails to rupture and continues enlarging. It usually forms during ovulation, and can grow to about 2-3 inches in diameter. It is thin-walled and filled with clear fluid.
rupture of folliclular cyst causes sharp pain (mittelschmerz), usually in mid-cyle.
Corpus luteum cyst
corpus luteum forms from ruptured ovarian follicle under the influence of LH, and secretes progesterone and estrogen In absence of conception, the corpus luteum usually breaks down and disappears.
It may, however, fill with fluid or blood, causing the corpus luteum to expand into a cyst.
It can however grow to almost 4 inches in diameter and has the potential to bleed into itself or twist the ovary, causing pelvic or abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sudden, sharp pain.
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Corpus luteum cysts are functional, and most of them completely disappear spontaneously. Being a thin-walled vascular structure, such cysts are predisposed toward rupture. Hemorrhage in the corpus luteum is a rare complication that occurs more frequently in younger women, especially when associated with pregnancy; May occur in adolesence, though uncommon.
( \'Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis\' : B. S. Hertzberg, M. A. Kliewer, E. K. Paulson - abdominal imaging )
\"A ruptured ovarian cyst can produce massive hemoperitoneum, with clinical symptomatology and sonographic features that closely mimic those of other disorders, in particular ectopic pregnancy. Considering the likelihood of both clinical and radiologic misdiagnosis, the radiologist should consider and pursue the diagnosis of a ruptured hemorrhagic ovarian cyst in a woman of child-bearing age who presents with pelvic pain and a large amount of complicated intraperitoneal fluid\"
\"In a woman in whom CT reveals the presence of an ovarian cyst with an enhanching rim and highly attenuated contents, as well as highly attenuated peritoneal fluid, a ruptured corpus luteal cyst should be suspected. Other possible evidence of this is focal interruption of the cyst wall and the presence of peritoneal fluid around the adnexa.\"
( \'Ruptured corpus luteal cyst : CT findings\' - Hyuck jae choi et al - korean j of rad )
Interestingly, and retrospectively, the CT findings do correlate...!