Ovarian apoplexy
Encyclopedia
Ovarian apoplexy is a sudden rupture in the ovary
, commonly at the site of a cyst, accompanied by hemorrhage in the ovarian tissue and/or intraperitoneal bleeding.
. The location from which the follicle emerges then forms a temporary cyst, called the corpus luteum, which produces hormones to continue the menstrual cycle and mature the uterine lining. This is the normal ovarian cycle.
In cases of dystrophic and sclerotic changes in ovarian tissue, acute and chronic inflammatory processes in the uterus, or in polycystic ovary syndrome
and some other diseases, as well as the result of medication that stimulate ovulation, certain irregularities in ovulation process and corpus luteum formation occur. As a result, blood vessels in the ovary contract, become dilated, and increase intra-ovarian bleeding. As a result a hemorrhage can occur in the corpus luteum
due to the fragility of blood vessels, causing a hematoma. All this is accompanied by pain, weakness, dizziness, nausea
, vomiting, pale skin, and/or fainting. If left untreated, internal bleeding may increase, creating a real threat to the health and life of the woman. Other possible causes of ovarian rupture include abdominal trauma, excessive physical stress, vigorous sexual intercourse, horseback riding, etc.
Sometimes there may be intermenstrual bleeding or spotting after menstruation.
Quite often, ovarian apoplexy occurs after intercourse or training in the gym, when pressure in the abdomen has increased or ovarian tissue has experienced some stress. However, rupture of ovarian tissue can occur in conjunction with other diseases.
However, according to recent data, this classification is inadequate, because the ovary cannot rupture without bleeding.
Therefore, a new pathology has been devised in which the condition is divided according to severity: mild, moderate and severe (depending on the magnitude of blood loss).
On examination, there is marked soreness of the affected ovary, and positive symptoms of irritation
of the peritoneum.
In a general blood test, a marked decrease in hemoglobin levels can be seen (in the anemic and mixed forms of ovarian apoplexy).
Pelvic ultrasound
reveals in the affected ovary a large corpus luteum cyst with signs of hemorrhage in it and/or free fluid (blood) in the stomach.
Because ovarian apoplexy is an acute surgical pathology, diagnosis must be confirmed rapidly, since delays between the event and surgical intervention increases the magnitude of blood loss and may be life-threatening.
s, and physiotherapy. In the presence or suspected internal bleeding, surgery is indicated via laparoscopy
or laparotomy
. Other treatments may include efforts to stop the bleeding or resection of the affected portion of the ovary. However, in cases in which there is extensive damage to the ovary, it may be necessary to remove it.
After being discharged from the hospital, it is important to take steps to prevent a recurrence in the future. Such steps include avoiding risk factors or beginning a regimen of oral contraceptives to control ovarian activity.
Ovary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
, commonly at the site of a cyst, accompanied by hemorrhage in the ovarian tissue and/or intraperitoneal bleeding.
Pathogenesis
In the ovaries of sexually mature women, follicles grow, and oocyte matures in them, to prepare for potential fertilization. As a menstrual cycle progresses, a dominant follicle begins to stand out, and in the middle of the menstrual cycle it reaches its maximum size of about 20mm. Then the follicle ruptures, releasing a mature egg, and this process is called ovulationOvulation
Ovulation is the process in a female's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum . Ovulation also occurs in the estrous cycle of other female mammals, which differs in many fundamental ways from the menstrual cycle...
. The location from which the follicle emerges then forms a temporary cyst, called the corpus luteum, which produces hormones to continue the menstrual cycle and mature the uterine lining. This is the normal ovarian cycle.
In cases of dystrophic and sclerotic changes in ovarian tissue, acute and chronic inflammatory processes in the uterus, or in polycystic ovary syndrome
Polycystic ovary syndrome
Polycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....
and some other diseases, as well as the result of medication that stimulate ovulation, certain irregularities in ovulation process and corpus luteum formation occur. As a result, blood vessels in the ovary contract, become dilated, and increase intra-ovarian bleeding. As a result a hemorrhage can occur in the corpus luteum
Corpus luteum
The corpus luteum is a temporary endocrine structure in mammals, involved in production of relatively high levels of progesterone and moderate levels of estradiol and inhibin A...
due to the fragility of blood vessels, causing a hematoma. All this is accompanied by pain, weakness, dizziness, nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, vomiting, pale skin, and/or fainting. If left untreated, internal bleeding may increase, creating a real threat to the health and life of the woman. Other possible causes of ovarian rupture include abdominal trauma, excessive physical stress, vigorous sexual intercourse, horseback riding, etc.
Symptoms
Clinical symptoms of apoplexy associated with the basic mechanism of this disease:- Pain, which occurs primarily mid-cycle or after a minor delay in menstruationMenstruationMenstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
(at the time of the rupture of a corpus luteum cystCystA cyst is a closed sac, having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.- Locations :* Acne...
, for example). Pain is most often localized in the lower abdomenAbdomenIn vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
. Sometimes the pain may radiate to the rectumRectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
or to the lumbar or the umbilical region. - Bleeding into the abdominal cavity, which may be accompanied by:
- low blood pressure
- increase in heart rate
- weakness and dizziness
- syncopeSyncopeIn phonology, syncope is the loss of one or more sounds from the interior of a word; especially, the loss of an unstressed vowel. It is found bothin Synchronic analysis of languages and Diachronics .-Found synchronically:...
- chills
- fever up to 38°C
- vomiting
- dry mouth
Sometimes there may be intermenstrual bleeding or spotting after menstruation.
Quite often, ovarian apoplexy occurs after intercourse or training in the gym, when pressure in the abdomen has increased or ovarian tissue has experienced some stress. However, rupture of ovarian tissue can occur in conjunction with other diseases.
Classification
- Painful type - the primary symptom is pain, without signs of intraperitoneal bleeding.
- Anemic type - the primary symptom is internal (abdominal) bleeding, without pain.
- Mixed type - a combination of pain and intraperitoneal bleeding.
However, according to recent data, this classification is inadequate, because the ovary cannot rupture without bleeding.
Therefore, a new pathology has been devised in which the condition is divided according to severity: mild, moderate and severe (depending on the magnitude of blood loss).
Diagnosis
Typical complaints appear during the middle or second half of the menstrual cycle.On examination, there is marked soreness of the affected ovary, and positive symptoms of irritation
Irritation
Irritation or exacerbation, in biology and physiology, is a state of inflammation or painful reaction to allergy or cell-lining damage. A stimulus or agent which induces the state of irritation is an irritant...
of the peritoneum.
In a general blood test, a marked decrease in hemoglobin levels can be seen (in the anemic and mixed forms of ovarian apoplexy).
Pelvic ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
reveals in the affected ovary a large corpus luteum cyst with signs of hemorrhage in it and/or free fluid (blood) in the stomach.
Because ovarian apoplexy is an acute surgical pathology, diagnosis must be confirmed rapidly, since delays between the event and surgical intervention increases the magnitude of blood loss and may be life-threatening.
Treatment
Treatment depends on the type of ovary apoplexy and the severity of intra-abdominal bleeding, but the condition must be treated in a hospital. In the case of pain without signs of intraabdominal bleeding, conservative therapy may be initiated, which includes bed rest, antispasmodicAntispasmodic
An antispasmodic is a drug or a herb that suppresses muscle spasms.-Smooth muscle spasm:One type of antispasmodics is used for smooth muscle contraction, especially in tubular organs of the gastrointestinal tract...
s, and physiotherapy. In the presence or suspected internal bleeding, surgery is indicated via laparoscopy
Laparoscopy
Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera...
or laparotomy
Laparotomy
A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.- Terminology :...
. Other treatments may include efforts to stop the bleeding or resection of the affected portion of the ovary. However, in cases in which there is extensive damage to the ovary, it may be necessary to remove it.
After being discharged from the hospital, it is important to take steps to prevent a recurrence in the future. Such steps include avoiding risk factors or beginning a regimen of oral contraceptives to control ovarian activity.