**5. Ovarian cysts**

Tumours of the ovary are common in women, with about 80% being benign and occurring in the reproductive age group [23]. Ovarian tumours are multifaceted and their classification is based on the historical cell of origin [24, 25]. About 70-80% of primary ovarian tumours are epithelial in origin, 10% stromal and 5% germ cell, while the rest fall into other groups [26]. Dermoid cyst is one of the commonest ovarian tumours in child-bearing age [27], and 10% of cases are diagnosed during pregnancy [28].

Generally, ovarian cysts that are painful may be as a result of torsion (Fig. 3), haemorrhage, rupture, be endometriotic or cancerous. Torsion of ovarian cyst commonly presents as severe acute lower abdominal pain that is often associated with nausea and vomiting. The abdomen is usually tender, with a palpable pelvic mass on bimanual pelvic examination and ultraso‐ nography would reveal a large ovarian cyst. Such patients should be managed in a hospital and they require emergency surgery, usually a laparotomy. Conservative surgery (cystectomy) is usually carried out, but sometimes ovarectomy is done.

**Figure 3.** Torsion of left ovarian cyst (see torted stalk). This patient also had subserous uterine fibroids.

Ruptured ovarian cyst presents in a similar way to torsion of ovarian cyst. The patient may be known to have an ovarian cyst but this is no longer seen on ultrasonography. There may be evidence of peritonitis, including chemical peritonitis if the cyst was originally a dermoid cyst [29], and haemoperitonium. The patient would probably require a laparotomy if the condition worsens and so should be admitted to hospital urgently.
