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Tuesday, October 14, 2014

Huge ovarian cysts


An ovarian cyst is a fluid-filled, thin-walled sac that forms within the ovary. These cysts are usually benign in nature, although they may cause symptoms such as abdominal pain, swelling or bloating and uterine bleeding. They can be as small as a pea or as large as an orange. Occasionally, they grow even larger, sometimes reaching truly gargantuan proportions.

A short report published in the British Medical Journal 1951 describes the cases of two ladies, both Christian Scientists, who were admitted to hospital in London during the flying bomb era with huge ovarian cysts. One cyst contained an impressive 76 pints (42 litres), the other 60 pints (33 litres) of brown viscous fluid. The fluid was drained first; afterwards, surgical removal of the cysts proved easy. Blood transfusion was unnecessary, but both patients received two pints (1100 mL) of plasma during the operation. They both made a full recovery.

The grainy old photo below shows the massive belly of one of the patients. Imagine lying in a hospital with over 30 litres of fluid in your abdomen, probably barely able to walk (if at all) and unable to care for yourself, while World War II is raging and London is being bombed by the Germans.




Something tells me, too, that the operation wouldn't have been the end of this unfortunate woman's problems. In those times, even after all the fluid had been drained, the excess skin probably wouldn't have been removed, leaving the patient with a hanging "apron" of skin that would have made walking and hygiene difficult (it's not easy to maintain cleanliness under a heavy skin fold, as many obese people know). The report doesn't specify how old the ladies were (I'm guessing at least middle-aged), or from what social class.

In the same year, the British Medical Journal published a letter describing the case of an 86-year-old woman who also suffered from an enormous ovarian cyst. There is no photo, but the description of the case is quite interesting and touching:

"A woman 86 years of age had been bedridden for 16 years, and the cyst had grown to a huge size. She refused operation because she thought it would kill her, and then became so uncomfortable that she decided to have the operation in order that it would put her out of her trouble. She was really nothing more than a small woman attached to an enormous cyst. It had to be propped up on either side, and she was very attenuated."

It was impossible to perform the operation in a hospital, since the patient's belly was so huge by now that she couldn't fit through the door. The surgeon arranged for an operating table to be brought into the room, but discovered that to operate, he needed to be near the electric light hanging from the ceiling, so he ultimately had to perform the operation on the patient's bed! The operation itself presented no technical difficulties. The patient's abdomen was tapped, and the fluid was allowed to flow into a zinc bath. When this container became full, it was carried into a nearby bathroom and emptied.

"A careful count was made of the emptyings of this bath, and then a measurement was made of the amount of fluid that was put into the bath [...] It amounted to 22 gallons (100 litres). She made a very steady recovery, but when she came out of the anaesthetic she refused to believe that she was alive. She thought that she had died and was a disembodied spirit because she could not feel her body [...] Her progress was steady, and she lived until she was 103. She became rather like Queen Victoria in appearance, for she put on weight, was round-faced, and was very much looked up to by her friends. She was very proud of the royal telegrams that were sent to congratulate her on her age. She ended her life very happily, mainly being very well."


16 years of lying bedridden is a very long time, but at least this story had a happy ending!




Literature: 

V. B. Green-Armytage (1951) Enormous Ovarian Cyst. Br Med J. 1(4715): 1145.

J. Collingwood Stewart (1951) Enormous Ovarian Cyst. Br Med J. 1(4718): 1332.

Wikipedia: Ovarian cyst


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