Apoplexy (rupture) of the ovary is a common cause of intra-abdominal bleeding, which requires urgent surgical intervention and threatens the life of the patient. It is important, without wasting time, to establish the correct diagnosis and differentiate it from ectopic pregnancy and appendicitis. What features of the clinical course of ovarian rupture indicate apoplexy? Read the main causes, symptoms and treatments for ovarian apoplexy at estet-portal.com.
Ovarian apoplexy - a sharp development of bleeding in the ovary due to its rupture. In this case, the ovarian tissues lose their integrity, resulting in intra-abdominal bleeding. The frequency of occurrence of such a pathology as ovarian apoplexy varies and is up to 3% of the total number of intra-abdominal bleeding.
Rupture of the ovary is more common in women aged 16 to 36 years. It is the right ovary that is most often affected due to the more abundant blood supply. Therefore, apoplexy is often confused with acute appendicitis.
Causes and predisposing factors of ovarian apoplexy
There are several types of pathologies in the ovary, which, with an increase in intra-ovarian pressure, bleed. These are ovarian cystoma and hemangioma. Bleeding can even be due to a small hole in the ovary. Intra-ovarian pressure increases with the growth of the follicle and with the growth of the hematoma. Ovarian apoplexy can be provoked by drug methods of ovulation stimulation, inflammation, which lead ovarian tissues to a state of degeneration and sclerosis. Varicose vessels, small cystic changes and chronic appendicitis are predisposing factors for ovarian apoplexy. In case of rupture of the ovary, pathologies in the endocrine system, neurovegetative system, blood diseases should be excluded.
Provoking factors of ovarian apoplexy also include:
- pregnancy;
- menstruation;
- physical overvoltage;
- abdominal injuries.
There are cases in the literature when, during a long stay in a sauna or in a hot bath on the day of ovulation, girls had ovarian ruptures, without the presence of pathologies in them.
Clinical presentation of ovarian rupture
Symptoms of ovarian rupture are expressed by sharp pain on the right or left (more often on the right). There are 3 forms of ovarian rupture, depending on the prevalence of symptoms. It is anemic, painful and mixed. Pain appears against the background of absolute well-being. With intense internal bleeding, symptoms of secondary anemia develop: a sharp pallor of the skin and mucous membranes, blood pressure decreases, and a frequent pulse. Sometimes, when an ovary ruptures, bloody discharge from a woman's genital tract may occur. There may be dry mouth, dizziness, nausea, vomiting, loss of consciousness. Pain may radiate to the rectum. At the same time, the abdomen is swollen, painful, positive phrenicus is a symptom. There is a symptom of irritation of the peritoneum. Percussion with a rupture of the ovary, dullness is noted in sloping places. When examined on a gynecological chair, there are no signs of pregnancy. Perhaps overhanging and soreness of the vaginal vaults, pain when the cervix is displaced. In the blood test - anemia.
What differentiates ovarian apoplexy?
In the anemic form of ovarian apoplexy, the process is differentiated from an ectopic pregnancy. At the same time, a test for the presence of chorionic gonadotropin is done. However, with a pronounced clinical picture of ovarian apoplexy with signs of internal bleeding, determining the exact diagnosis is of no practical importance, because in both cases urgent laparotomy is indicated.
Often the pain that occurs with ovarian apoplexy must be differentiated from acute appendicitis. In acute appendicitis, there is no connection with the menstrual cycle, the point of maximum pain is determined in the middle of the line that connects the navel to the anterior-superior axis of the right iliac bone (Mac Burney's point). With a rupture of the ovary, this point of maximum pain is localized below. In a vaginal examination with acute appendicitis, there will not be such a sharp pain when the internal genital organs are displaced, as with ovarian apoplexy. In the blood test for appendicitis, there will be leukocytosis with a tendency to rapidly increase, which will not happen with ovarian apoplexy.
Basic Treatments for Ovarian Rupture
If the diagnosis is established and there is no profuse internal bleeding, conservative measures can be limited - an ice pack on the stomach and anti-inflammatory therapy.
In case of significant internal bleeding into the abdominal cavity, surgical intervention with resection or suturing of the ovary is necessary. The ovary is completely removed only in case of heavy bleeding.
Women who have had ovarian apoplexy should take combined estrogen-progestin contraceptives for 3-6 months in order to suppress ovulation and correct hormonal disorders.
After the surgical treatment of ovarian rupture, the woman is recommended health procedures and rest in sanatoriums and dispensaries.
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