Anorectal fistula

MULTILOCULATED OVARIAN CYST *Chief Complaints* 46 year old female presented with sudden onset lower abdominal pain *History* 46 year old para 2 previous 2 LSCS presented with history of lower abdominal pain which was sudden in onset associated with nausea. Pain was not relieved by any medication. No history of abdominal distension or bloating. No history of loss of appetite or weight. *Vitals* Pulse 90/ min. BP 144/86 mmHg. *Physical Examination* Per abdomen there was mass palpable of variegated consistency around 24 weeks size of gravid uterus more on right side occupying right ileac fossa , right lumbar region and suprapubic region. Tenderness present on deep palpation. No free fluid. *Investigations* Ultrasound done revealed right ovarian neoplasm with multiple septae. CA 125 was 28 *Diagnosis* Right ovarian neoplasm with torsion *Management* Patient was taken for emergency laparotomy and proceed. OT findings Uterus normal size. Right sided multiloculated ovarian cyst with mucinous content . Fluid in cyst around 1.5 litres. No surface growth/ excrescences. Evidence of torsion of two and half turns around infundibulopelvic axis. Left ovary and fallopian tube normal. Right salpingo ovariotomy done. Patient fine