Atypical Presentation and Surgical Management of a Migrated Ovarian Cyst During Cesarean Section: A Case Report

Abstract

Ovarian cysts are a common occurrence during pregnancy and are typically benign and asymptomatic. Their treatment is based on size, symptoms, and possible complications. Most cysts can be limited to the adnexal region, but as the embryo grows, anatomical displacement may cause some unexpected intraoperative findings. We report the case of a 32-year-old primigravida with a progressively enlarging ovarian cyst, initially measured at 70 mm and later reaching 95 mm by term. Repeat prenatal ultrasounds consistently localized the cyst to the right adnexal area. During elective cesarean section, however, the cyst was not found in its expected location. Extensive intraoperative exploration revealed the mass in the upper abdomen, near the liver and adherent to the posterior abdominal wall. Due to its high position, removal through the standard Pfannenstiel incision was not feasible. A paramedian incision was performed, allowing successful excision of the cyst with no intraoperative or postoperative complications. This case highlights the potential for adnexal masses to migrate during pregnancy, complicating surgical management. It underscores the importance of thorough intraoperative exploration and surgical adaptability when imaging findings do not correlate with anatomical reality. The innovative use of a paramedian incision enabled safe and effective removal of the cyst, demonstrating a successful outcome in a complex scenario. This report contributes valuable insight into the management of atypically positioned ovarian cysts during cesarean delivery.