Is it Hydrosalpinx....To operate or not to operate??

Dr. Goodman, thank you in advance for your opinion. I am 27 and had laparoscopic surgery in March on a complex cyst that grew from 5.1cm with internal echoes and a septation w/ vasc. mural thickening TO 5.7cm w/ debris, new small daughter cysts and a septation meas. 3mm in thickness after 6wk f/u. Normal ovarian tissue was compressed along the inferior aspect of the cyst and there was no color flow seen within the wall of it. So they took my right ovary and tube. The cyst ruptured and the bag slipped, spilling contents into my abdomen, but they got out what they could. Somehow, my ob-gyn punctured my cervix and I had a stitch put in. I had a small infection at my navel incision. "Nuisance" things as my doc puts it. The path. came back as a mucinous cystadenoma. But, 8wks. post-op, I started feeling weird again. I got another u/s in May, it showed a 4cm complex cyst in lt. ovary with numerous thin sept. throughout, felt most compatible to be hemorrhagic. And small amt. of free pelv fluid in right adx region and also a small tubular appearing structure containing fluid wthich may represent a small amt of residual fluid filled rt. salpinges. Then I had a f/u u/s in June 6wks. later and it show the left large hemorrhagic cyst was improving and was now a 1.9cm predominantly solid lesion with a small central cyst and the rim was mildly hypervascular. The right adnexa has a small tubular fluid collection about 1.7 x0.8 x1.0 with some debris still seen in it, could be hydrosalpinx or post-op fluid with small amt. of debris. ....(cont'd on next post...)

[Annekathryn Goodman, M.D.]

Hi  Raynbow,
It sounds like you have been through a lot in the past six months!
If you have been reading any of my other answers, you know I am a fan of laparoscopy to help understand what is going on. So, in general, I do not have any disagreement with the thought to take a look again with laparoscopy.

However, here are some other thoughts for you to meditate on. :
You had a mucinous cystadenoma of the right ovary and you had intraoperative rupture.

A mucinous cystadenoma is one of the types of benign tumors that comes from the lining of the ovary (called the epithelium). There are four benign cell types seen in benign epithelial tumors (called cystadenomas)

[Raynbow]

So...I waited 8wks. this time and had my f/u in Aug. It showed that there was an interval increase in the amt. of tubular appearing fluid complicated by some septations and debris in the rt. adx. region of indeterminate etiology. It could conceivably represent some fluid engorgement of remaining post-op rt. salpinx. It measures 4.2 X 1.9 X 1.8cm and approx. 10cc of fluid. The left ovary now contains a 3.3cm cyst with a slightly thick avascular septation. The ovary is enlarged to 4.3 x 3.0 x 3.9cm compared to 3.9 x 2.6 x 2.2cm on prior u/s.
Now, I am scheduled for surgery on this matter on the 15th.
*Is it unreasonable to do this or should I wait?? I don't want it to grow 2 more cm. and ruin my ovary like the last muc.cyst did. The doc said he would drain it first and if it looks muc. or ser. he will do a cystectomy to save the ovary. He seems to think the rt side could be hydrosalpinx, my appendix, or mucinous fluid accumulating from the spill at my last surgery 6mo ago. *How could I have hydrosalpinx after a tube removal??
*Is it likely that it is mucinous fluid in my cyst and my right side?? I just basically want to know if I should wait another 8wks or go ahead with the surgery....based on your experience, what do you think? Thanks so much!
(((Raynbow

[Raynbow]

Thank you for the details!
Now, is an ob-gyn qualified to do an appendectomy if needed during laparoscopy or is that a referral to a gen. surgeon?
Also, no I didn't have anything associated with my left ovary previously, except for some free fluid adjacent to it. No signs of endo during surgery.
And even though I don't want to do this surgery, my instinct tells me I need to and thank you for easing my doubts.
(((Raynbow

[akg]

Hi there, some OB Gyns feel comfortable doping appendectomies. You should ask yours to see. good luck to you