Global Journal of Medical Research, E: Gynecology and Obstetrics, Volume 21 Issue 3

The ovarian tumors were huge with size ranging from 30 x 35 centimeters to 20 x 25 centimeters. The tumors underwent torsion for more than 5 turns In most of the cases with onset of gangrenous ovary in some cases, however were managed with great surgical expertise and precision and timely intervention so as to minimize the intra – operative and post- operative complications. The histopathological report included epithelial tumors like serous and mucinous cystadenomas and non epithelialtumors like granulosa cell tumors and fibrothecoma were mainly from the high income group. • The American College of Surgeons proposed stratification of surgical cases according to the patient’s clinical condition and the severity of the disease as low, intermediate, or high severity. • Emergency (<1h): Peritonitis by tubo-ovarian and/or pelvic abscess, necrotizing fasciitis in surgeries for pelvic and breast neoplasms; • Urgent (<24h): Postoperative infections, acute inflammatory abdomen (adnexal torsion, myoma torsion, ovarian cysts), hemorrhagic conditions (ovarian cysts); • Elective urgent (<2 weeks): Surgeries for neoplasms of the lower genital tract and breast previously diagnosed by pathological examination; • Essential Elective (>2 to <3 months): Hysteroscopy for abnormal uterine bleeding (unknowledge causes, suspected malignancy, and menopausal transition), postmenopausal bleeding (suspected malignancy), cervical conization or looped electro excision procedure (to exclude neoplasm in the lower genital tract) • Non-essential/elective surgery: Infertility procedures, family planning procedures (bilateral tubal ligation procedure). The protocol followed at our tertiary care institute before operating the cases were as follow- 1) All elective patients should be admitted to Transit ward initially. Swabs should be sent for all patients from there. 2) After swab reports patients should be segregated into Covid/Non Covid Category. 3) Covid POSITIVE swab patients should be transferred to COVID facility/Centre (St. George’s Hospital). 4) COVID NEGATIVE Swab patients should be transferred to respective unit wards. 5) Repeat swab should be sent for these patients from their respective wards 72 hrs. before proposed surgery. 6) All patients should have at least two consecutive negative swab reports, of which the latest swab should be within 72 hours of planned procedure. 7) All OT Healthcare workers, patients and visiting relatives should be screened before entering OT as per protocol. If found suspect/symptomatic, should not be permitted to OT, and should be sent to designated swab collection facility. 8) All OT Personnel should follow COVID sanitisation protocols on entry to OT with repeated handwashing, social distancing and adequate protective gear. 9) Visiting relatives of the patients should also have COVID Negative swab report prior to entry to OT/wards. • Re-evaluate admitted patients for signs and symptoms of COVID-19 • Encourage Physical Distancing (maintaining distance of 6 feet) • There should not be any adjoining inhabited buildings within 20 meters • There should be separate changing rooms for male and female heath care workers with attached toilet and shower facilities • Ideally, independent changing rooms with toilet and shower facility should be there for doctors, nurses and support staff • There should be provision for opening the doors with feet or elbow without touching the handles • Non elective surgeries postpone – at least 4 weeks The ovarian cases presenting to the gynecology is not new. However during the COVID-19 pandemic a varied presentation was observed and hence demanded a study of such cases. Some of the selected cases are mentioned as follows- CASE 1 A Case of 30 years old, married since 14 years Parity 3, Living 3, who presented with acute pain in abdomen. Her Ultrasound Abdomen + Pelvis was suggestive of heterogeneous to isoechoic solid lesion in left adnexa measuring 10.8 x 1.3 x 5.1 cm with ovarian vein engorgement & displacing the uterus inferiorly. cystic areas seen within suggestive of neoplastic lesion On Examination, her general condition was fair, vitals normal, no pallor/edema/icterus, cardiovascular/ respiratory system – within normal limits. On per abdomen examination, a 10x 8 cm hard, firm mass felt, irregular margins, lower border palpated, restricted mobility, generalised tenderness and guarding was present. On per speculum examination, white discharge was seen, uterus not felt separately from mass. Tumor markers weresent: CA125 – 7.25, CEA- 2.38, rest tumor markers-WNL Contrast Enhanced Computed Tomography done on 11/2/2021 was suggestive of torsion of ovary along with part of fallopian tube. On 13/2/2021, Patient was taken up for Emergency exploratory laparotomy done with ovarian 3 Year 2021 Global Journal of Medical Research Volume XXI Issue III Version I ( D ) E © 2021 Global Journals A Study of Giant Ovarian Tumors Presenting with Higher Incidence of Torsion: A Journey of my Experience in Covid-19 Pandemic at Tertiary Care Centre