Many women have asked what is a chocolate cyst? Also called an endometrioma, it is one of several types of cysts on ovaries that affect women. A chocolate cyst is a sac or pouch growing on the ovary that contains fluids and sometimes semi-solid material too, in which case it may be referred to as a complex ovarian cyst. Because the endometrial tissue inside the cyst responds to monthly hormones it bleeds and fills the interior of these cysts with unclotted blood. Chocolate cysts get their name from the dark old blood that grossly resembles chocolate. Other names for chocolate cyst are endometrial cyst, endometrioma cyst, and chocolate ovarian cyst.
How do chocolate cysts develop?
A women with the disease endometriosis will have tissue from the inside surface of her uterus (endometrium) attach to the ovary. These patches of endometrial cells may form small cysts that multiply into even more cysts when stimulated by menstrual hormones. As the cysts spread they can become part of the ovary itself, replacing the normal tissue needed for ovulation. Inflammation and irritation of nearby organs may result from chocolate cysts spreading around the pelvic cavity. Millions of women will be affected by endometriomas each year. Approximately five to ten percent of all women will have one at some point during their life, typically during their childbearing years. One of the critical problems with chocolate cysts is that they tend to reoccur. Usually, the size of an endometrioma ranges from about half an inch (grape size) to four inches or more (softball size) in diameter.
Pregnancy and Infertility with Chocolate Cysts:
Many women are interested in knowing if a chocolate cyst will prevent or interfere with pregnancy. It is possible for a woman to still get pregnant even without removing the endometrioma . The answer is not so clear cut in more advanced cases in which multiple cysts are present and some are larger than a few inches in diameter. But laparoscopy definitely increase pregnancy rate. Some studies have shown pregnancy rates of 50% in the first 3 years following treatment. Further, the chances of getting pregnant are optimized within about six months after successful treatment and healing of the ovaries. In the final analysis, the health of the patient and her wishes for childbearing will be important factors contributing to the planning of a successful pregnancy.
Chocolate Cysts Symptoms:
The symptoms of a chocolate cyst are similar to endometriosis symptoms since the underlying disease is the same. Some other conditions mimic this disease including ovarian cyst symptoms, pcos symptoms, and ectopic pregnancy. Not all women will have the same symptoms. In fact, some may have severe symptoms while others have none at all. The extent and severity of symptoms do not always correlate with how far the disease has progressed. For example, it is possible for an endometrioma to be present for a long time without symptoms or conversely be very noticeable in the early stages of its growth.
Abdominal cramping or swelling during a menstrual cycle is a very common symptom for women with endometriomas. Another possible sign of a cyst is progressively painful periods. Pain may also be felt while emptying the bowels or bladder. Sexual intercourse and other physical activities such as exercising or bending and stretching may be painful. In some cases a cyst may press upon the ovary causing it two twist until its blood supply is cut off. This often results in intense, sharp pain.
Chocolate cyst rupture can also be a source of severe pain. If a chocolate cyst ruptures the contents may spill out onto the ovaries and other organs of the pelvis. This can lead to complications such as adhesions (scarring), infection, and intense pelvic pain. A ruptured ovarian cyst can be a serious medical emergency and you should do something right away if you have symptoms such as excessive bleeding, fever, vomiting or severe pain.
Bleeding outside the usual menstrual cycle is another symptom of endometriomas. A woman may notice her bleeding is occurring at odd times or spotting in between periods. Post-menopausal women who have vaginal bleeding should also be concerned about the presence of a cyst. Excessive bleeding and dark colored discharge from the vagina are other possible symptoms of a chocolate cyst.
Indication of surgery:
Objective:
Dysmenorrohea, Dysparenunia & pelvic pain & Infertility are the presenting symptoms. Chocolate cysts may be found in Infertility patient during trance vaginal USG evaluation. Endometriosis is the commonest cause of Infertility during Laparoscopy. Most rewarding results are achieved following Laparoscopic surgery with pregnancy rate from 50 to 70% in different series for chocolate cyst with Endometriosis. Cystectomy should be preferred over simple drainage for preventing reoccurrence. But if we feel that cystectomy dissection is too difficult & likely to destroy many normal ovarian follicles, we do drainage & bipolar fulguration of internal surface of chocolate cyst( depending on serum AMH Level). Rectovaginal endometriosis is carefully evaluated during Laparoscopy. Right cleavage & proper dissection of recto-vaginal nodule for her pain relief is paramount importance.
Benefits of Laparoscopy Surgery:
Average Stay in Hospital:
14 to 26 hours. (DAY CARE SURGERY)
Average Duration of Surgery:
For normal Laparoscopy procedure takes about 25 to 75 minutes only. For advanced Endometriosis it may take 1-2 hours
Average Blood loss during Surgery:
50-100 cc.
Average time after operation to resume normal activities/work:
Many patients undergo Laparoscopy as Day care procedure, returning home within 24 hours of surgery. Most begin feeling much better within one day.
Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)
Post-operative Course:
Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain-free. Patient can take fluids 3-4 hours after laparoscopy & light food after 6-8 hours. She may feel little abdominal & shoulder pain after laparoscopy for 24-48 hours but it cam be relived with pain killer tabs. Most of the patients can walk normally without support and can take normal diet 12 hours after the laparoscopy. She can be discharged on the next day of the operation. Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. For 5 days following laparoscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow-up 7 days after the Laparoscopy for dressing.
Dr. Kapil Kanade had already done more than 450 Chocolate Cysts Surgery Successfully. He has high level of experience in performing successful Chocolate Cysts surgery all over Maharashtra.