Background: Articles on giant ovarian cysts have become less common in medical literature. These cysts mimic ascites, presenting with abdominal distension and shifting dullness. They are predominantly serous and mucinous cystadenomas. Rare cases of low-grade of malignant tumors and adenocarcinomatous ovarian cysts have been reported. Materials and Methods: This was a retrospective descriptive study of 5 cases recruited between 2009 and 2012. The selected patients had large ovarian cysts extending to the epigastric region. Solid, mixed, or predominantly solid ovarian cysts were excluded from the study. Results: The mean age of the patients was 28, with extremes of ages 22 and 39. Ascites was detected clinically with transabdominal fluid thrills in all cases. Cysts were unilocular in 4 cases and multilocular in 1 case. Oophorectomy and salpingectomy were performed without preoperative drainage. Histology testing showed serous cystadenoma in 4 cases and mucinous low-grade adenocarcinoma in 1 case. The average follow-up time was 54 months. No recurrences were observed. Conclusions: Imaging (ultrasound, computed tomography, and/or magnetic resonance imaging) is paramount for planning management of giant ovarian cysts as imaging facilitates the distinction between ascites and pseudoascites as well as the identification of any suspicious features of malignancy (multiple partitions, and endo-or exocystic vegetations). Complete excision without opening the cyst is the procedure of choice. ( J GYNECOL SURG 32:162)

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