Ovarian apoplexy (ovarian rupture) – a sudden rupture (integrity violation) of ovarian tissue, accompanied by bleeding in the abdominal cavity and pain.
In the ovaries of a mature woman, follicles grow; the eggs mature in them, that is, preparation for the upcoming pregnancy. From the beginning of the menstrual cycle, the dominant follicle begins to grow, which reaches its maximum size, about 20 mm, by the middle of the menstrual cycle. Then the follicle membrane breaks, releasing a mature egg, – ovulation occurs In place of the bursting follicle, a temporary formation forms – the corpus luteum, which produces certain hormones that prepare the woman’s body for pregnancy. This is the normal course of the ovarian cycle.
With dystrophic and sclerotic changes in ovarian tissue, which occur in acute and chronic inflammatory processes in the uterine appendages, with polycystic ovary syndrome and some other diseases, as well as with drug stimulation of ovulation, certain disorders occur during ovulation and the formation of the corpus luteum. As a result, the blood vessels at the site of rupture of the ovary are poorly contracted, intra-abdominal bleeding continues and intensifies, and hemorrhage, a hematoma, forms in the corpus luteum due to the fragility of the vessels. All this is accompanied by pain, weakness, dizziness, nausea, vomiting, pallor of the skin, fainting. Without appropriate treatment, internal bleeding can intensify, creating a real threat to the health and life of a woman. Other factors that can cause ovarian rupture include abdominal trauma, excessive physical exertion, violent intercourse, horse riding, etc.
Frequency and forms of ovarian apoplexy
Ovarian apoplexy (ovarian rupture) sudden rupture (integrity violation) of ovarian tissue, accompanied by bleeding in the abdominal cavity and pain.
Among the causes of intra-abdominal bleeding, 0.5-2.5% is due to ovarian apoplexy.
There are 3 forms of ovarian apoplexy, depending on the prevailing symptoms:
- A painful form when there is a pronounced pain syndrome, but there are no signs of intra-abdominal bleeding.
- Anemic form, when symptoms of internal (intra-abdominal) bleeding come first.
- The mixed form combines the signs of pain and anemic forms of ovarian apoplexy.
However, according to modern data, this classification is considered inferior, since ovarian rupture without bleeding is impossible.
Therefore, at present, this pathology is divided into several degrees of severity: mild, moderate and severe (depending on the amount of blood loss).
Symptoms of ovarian apoplexy
Clinical symptoms of apoplexy are associated with the main mechanism for the development of this pathology:
- Pain syndrome, which occurs primarily in the middle of the cycle or after a slight delay in menstruation (for example, when the corpus luteum cyst ruptures) Pain is most often localized in the lower abdomen. Sometimes pain can radiate to the rectum, lumbar or umbilical region.
- Bleeding into the abdominal cavity, which may be accompanied by:
- pressure reduction;
- increased heart rate;
- weakness and dizziness;
- syncopal conditions;
- chills, fever up to 38 ° C;
- single vomiting;
- dry mouth.
Occasionally, intermenstrual bleeding or bloody discharge may occur after a delay in menstruation.
Quite often, ovarian apoplexy occurs after intercourse or training in the gym, that is, under certain conditions, when the pressure in the abdominal cavity rises and there may be a violation of the integrity of the ovarian tissue. However, rupture of the ovary can occur against the background of complete health.
Causes of ovarian apoplexy
Causes contributing to the occurrence of ovarian apoplexy:
- Pathological changes in blood vessels (varicose veins, sclerosis).
- Previous inflammatory processes of ovarian tissue.
- The moment of ovulation.
- Stage of vascularization of the corpus luteum (middle and second phase of the cycle).
Risk factors contributing to the occurrence of ovarian apoplexy:
- Weightlifting or heavy physical exertion.
- Violent intercourse.
Diagnosis of ovarian apoplexy
The correct clinical diagnosis of ovarian apoplexy is only 4-5%.
Diagnostic errors are explained, first of all, with the fact that the clinic of this disease does not have a characteristic and develops as another acute pathology in the abdominal cavity and small pelvis.
The patient is brought to the hospital with a diagnosis of “Acute abdomen.” Clarification of the reason is carried out in a hospital.
First of all, ovarian apoplexy must be differentiated from ectopic pregnancy and acute appendicitis.
As a rule, in the presence of a clinic of “acute abdomen”, consultation of related specialists (surgeons, urologists) is also necessary.
The most informative research methods are:
- Typical complaints of acute abdominal pain that appeared in the middle or second half of the menstrual cycle.
- On examination, marked soreness from the affected ovary is noted, and also symptoms of peritoneal irritation become positive.
- A general blood test may show a decrease in hemoglobin levels (with anemic and mixed forms of ovarian apoplexy).
- Puncture of the posterior arch, allowing to confirm or refute the presence of intra-abdominal bleeding.
- An ultrasound scan that allows you to see a large corpus luteum in the affected ovary with signs of hemorrhage in it and / or free fluid (blood) in the abdomen.
- Laparoscopy, which allows not only 100% to establish a diagnosis, but also to correct any pathology.
- Окончательный диагноз апоплексии яичника почти всегда устанавливается во время операции.
The final diagnosis of ovarian apoplexy is almost always made during surgery.
Ovarian Apoplexy Treatment
Conservative treatment is possible only in the case of a mild form of ovarian apoplexy, which is accompanied by minor bleeding into the abdominal cavity.
Patients with a mild form of apoplexy complain primarily of pain in the lower abdomen.
However, the data of many researchers prove that with conservative management of such patients in 85.7% of cases, commissures form in the pelvis.
Almost every 2nd woman after conservative management may cause relapse (repeated ovarian apoplexy). This is due to the fact that blood and clots that accumulate in the abdominal cavity after rupture of the ovary (ovarian apoplexy) do not wash out, as during laparoscopy, remain in the abdominal cavity, where they are organized and contribute to the formation of an adhesion process in the small pelvis.
Conservative treatment can be recommended only to women who have already realized their reproductive function (that is, already having children and not planning to have them) if they have a mild form of ovarian apoplexy.
If a woman is in reproductive age and is planning a pregnancy, then tactics even in the case of a mild form of ovarian apoplexy should be reviewed in favor of laparoscopy.
Surgical treatment is the main, because not only allows you to clarify the diagnosis, but also to conduct a full correction.
In all cases of apoplexy, laparoscopy is possible!!!
The only contraindication to the use of this access is a hemorrhagic shock (that is, very large blood loss with loss of consciousness).
The operation must be carried out in the gentlest way with the preservation of the ovary.
As a rule, cyst capsule removal, coagulation or suturing of the ovary is performed. In rare cases, with massive hemorrhage, ovarian removal is required.
During the operation, it is necessary to thoroughly rinse the abdominal cavity, remove clots and blood, to prevent the formation of adhesions.
Rehabilitation measures for ovarian apoplexy
Rehabilitation after an ectopic pregnancy should be aimed at restoring reproductive function after surgery. These include: prevention of adhesions; contraception; normalization of hormonal changes in the body. To prevent the adhesion process, physiotherapeutic methods are widely used:
- alternating pulsed magnetic field of low frequency,
- low frequency ultrasound,
- currents of a natal frequency (ultratonotherapy),
- low-intensity laser therapy,
- electrical stimulation of the fallopian tubes,
- electrophoresis of zinc, lidase,
- pulsed ultrasound.
During the course of anti-inflammatory therapy and for another 1 month after the end, contraception is recommended, and the question of its duration is decided individually, depending on the age of the patient and the characteristics of her reproductive function. Of course, one should take into account the woman’s desire to maintain reproductive function. The duration of hormonal contraception is also strictly individual, but usually it should not be less than 6 months after surgery.
After the completion of rehabilitation measures, before recommending the patient to plan the next pregnancy, it is advisable to perform diagnostic laparoscopy, which allows assessing the condition of the fallopian tube and other pelvic organs. If during control laparoscopy no pathological changes were detected, then the patient is allowed to plan a pregnancy in the next menstrual cycle.