Apoplexy ovary or ovarian rupture, an acute condition that occurs due to a sudden violation of the integrity of ovarian tissue, accompanied by intraperitoneal bleeding and pain. Apoplexy of the ovary in women of reproductive age, the most common in the age group from 25 to 40 years. Apoplexy of the ovary on the right side occurs several times more often than the left, which is associated with a stronger right ovarian artery hyperemia due to anatomical features.
Causes of ovarian apoplexy
The immediate cause of ovarian apoplexy are always disturbances in blood vessels and tissues of the ovary, usually formed as a result of chronic inflammation. Changed both the ovarian tissue and blood vessels, its supply (sclerosis, scarring, varicose veins) lead to increased risk of fracture. On certain days of the menstrual cycle (the middle and the second phase of the cycle) increases the load on the vessels, which in combination with pathological changes and provoking factors is the cause of ovarian apoplexy.
Factors that could serve as an additional cause of ovarian apoplexy are:
- Diseases of the blood, where it is broken clotting, as well as long-term use of anticoagulants;
- Hormonal disorders, contributes to the blood supply of ovarian tissue, including caused by artificial stimulation of ovulation;
- Neuropsychiatric factors and stress.
All of the above sets the stage for ovarian apoplexy occurred. When there is a combination of such factors and pathological changes of the blood vessels and ovarian any physical force, causing the tension of the muscles of the abdomen, may be the last straw, the external cause of ovarian apoplexy. That effort is often violent sexual intercourse (most often), sports, horseback riding, etc. In some cases, ovarian apoplexy can occur spontaneously during a complete rest.
Types of ovarian apoplexy
Depending on the severity of various symptoms of ovarian apoplexy divided into the following form:
- Pain (psevdoappendikulyarnaya). The most striking feature is the severe pain, accompanied by nausea, which is why this form is often mistaken for ovarian apoplexy attack of appendicitis;
- Hemorrhagic (anemic). The leading symptoms of ovarian apoplexy in this form are signs of internal bleeding: paleness, weakness, dizziness, up to fainting;
- Mixed combining symptoms of ovarian apoplexy two previous forms.
It should be noted that the division is rather arbitrary and superficial, as bleeding takes place not only in hemorrhagic, but also in the form of a painful ovarian apoplexy. In this regard, currently accepted classification of ovarian apoplexy depending on the bleeding. So, there are the following forms of ovarian apoplexy:
- Easy, the value does not exceed 150ml of blood loss;
- Moderate blood loss of 150 to 500 ml;
- Weight, blood loss greater than 500ml.
The disadvantage of this classification is that it is usually accurate quantitative blood loss can be set now only directly during surgery.
Symptoms of ovarian apoplexy
The main symptom of ovarian apoplexy is an acute sudden pain in the lower abdomen from the defeat. Pain intensity can be accompanied by nausea and even vomiting. When the pain the form of apoplexy ovarian pain usually radiates not concentrating in the area of the lesion. Signs of bleeding in this case is mild, which is very difficult to diagnose.
For hemorrhagic (anemic) form intense pain is not peculiar, but pain may also be present, in a less severe form than the pain ovarian apoplexy. However, in this case, the pain is radiating character, that is given in the lower back, pelvis, rectum and even the vulva. The main symptoms of ovarian apoplexy in this case are the symptoms of anemia: pallor, cyanosis of the lips and nails, weakness, shortness of breath, dizziness and fainting.
When mixed form ovarian apoplexy symptoms characteristic pain and anemic forms will be combined: severe pain on the part of the affected ovary on the background of anemia.
Diagnosis of ovarian apoplexy
As already mentioned, the diagnosis of ovarian apoplexy presents significant difficulties because of nonspecific symptoms. The patient complained of typical of acute abdomen in general, or the sudden anemia. Sometimes it may be informative ultrasound, also for suspected ovarian apoplexy carried posterior vaginal fornix puncture, diagnostic feature is the presence of free blood in the field. The most reliable and error-free method of diagnosis in this case is a laparoscopy - endoscopy of the abdominal cavity. Laparoscopy in the case of ovarian apoplexy is both a diagnostic and therapeutic method.
Treatment of ovarian apoplexy
Treatment of ovarian apoplexy should be urgent, as this life-threatening condition. In that case, if blood loss is stopped and reaches a significant size, the effect of ovarian apoplexy can even be fatal. In addition, the consequence of apoplexy of the ovary can become peritonitis, which developed as a result of exposure to blood on the peritoneum, which is also life threatening.
Previously it was thought that treating ovarian apoplexy can be both conservative and surgical. The indication for conservative treatment of ovarian apoplexy was accepted to consider the shape of pain, with little blood loss. However, as a result of many years of practical observations, it was found that conservative treatment of ovarian apoplexy, even in case of minor bleeding has adverse long-term consequences. Blood streamed into the peritoneal space, even in small quantities, is an active medium, which causes aseptic (non-bacterial) inflammation. At the site of inflammation formed adhesions that violate the normal structure of both the ovary and surrounding structures. The consequence of ovarian apoplexy in this case is very often infertility.
Thus, the most appropriate treatment for ovarian apoplexy is a surgical procedure, which in most cases (except for the most severe forms of the disease) is performed by laparoscopy. Therapeutic decisions in this case consists in removing from the abdominal cavity and extravasated blood washing it with an antiseptic solution if necessary suturing the damaged vessel. Postoperatively, conduct a comprehensive drug treatment ovarian apoplexy, aimed at eliminating the causes of pathology: the normalization of metabolic and hormonal processes, elimination of chronic inflammation, etc.