a 40 yr female h/o hysterectomy before 2 yr.Now her complain are pain in epigastrium while investigated usg shows cystic adenexa . is it possible ??then how it treat give me opine



Cystic lesions possible from the left over ovaries. Incidental diagnosis. Do MR pelvis to characterize the cysts, serum Ca 125, ca 19-9. But this will not cause epigastric pain.Give symptomatic treatment with antacids and review reports. Take gastroenterology opinion.

Was both ovaries removed during hysterectomy . If not cyst can develop in the ovary . If you have lap you do diagnostic lap and then proceed with open or continue with lap . Please do tumour markers. Cysts of residual ovary can be a little difficult because of adhesion of previous surgery . The epigastric pain may be a different entity .

Even if small asymptomatic, normal tumour markers, MRI shows clear simple cyst, should we proceed with surgery or can wait and repeat the scan after 2 or 3 months. Please opine.

Go for MRI abd and CA-125 If No malignancy detected go for fluid aspiration under USG and tt according to cytological reports Epigastric pain is not due to cyst Tt that with antacids and antispasmodic drugs Tt cystitis with appropriate antibiotics

Epigastric pain may not be related to cyst ,it may be due to other cause investigate her for LFT Serum Amylase CBC. Keep her on conservative treatment and follow up

What was the indication for hysterectomy Dr?

Fibroid uterus also tumour and appendicitis

For epigastric pain treat with PPI and go for upper GI Endoscopy.If it is inconclusive dealt cyst as advised by Dr.Vasanthakumar.

nothing to be done for adenaxal cyst if pt is asymptomatic and tumour marker normal, if epigastric pain is there give her ppi and coservative management

Operation advise surgeon best suggestion Only

Rule out endometriotic cysts .do diagnostic laparoscopy.In endometriosis epi pain can be there because of peritoneal leakage.Rule out after proper history

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