Ovarian apoplexy – an emergency condition in gynecology.
Characterized by a sudden violation of the integrity of the ovarian tissues (ovarian rupture). It is sometimes even called ovarian infarction. Accompanied by hemorrhage in the ovarian tissue, varying degrees of bleeding in the abdominal cavity, and acute pain syndrome.
Ovarian apoplexy occurs in 1-3% of women with gynecological pathologies, most often in the age group of 20-35 years. More often develops right ovarian apoplexy, which is associated with its intense blood supply to the right ovarian artery, which is a blood vessel directly out of the aorta, while the left ovarian artery feeding the left ovarian artery is a branch of the hepatic artery.
It is also noteworthy that the right ovary is larger and heavier than the left, and the lymphatic system is relatively better developed than the left ovary.
Clinical-morphological signs distinguish bruises:
- From an ovarian follicular cyst;
- From mature follicles during ovulation;
- From the ovarian stroma;
- From a yellow body cyst (dysfunctional ovary).
Ovarian apoplexy in 0.5-2.5% of cases is accompanied by bleeding in the abdominal cavity.
Ovarian apoplexy is provoked by abdominal trauma, physical exertion, exercise, sexual intercourse and all the factors that contribute to the increase in abdominal pressure. Not infrequently, ovarian failure correlates with the development of appendicitis. This pathology can develop at any stage of the menstrual cycle, although it most often occurs during ovulation or during the onset of menstruation, when gonadotropic hormone levels peak. The ovary may also rupture during menstruation.
The main symptoms
The main symptom of ovarian apoplexy is severe pain and signs of internal bleeding.
The pain arises suddenly and is localized in the lower abdomen, may radiate to the umbilicus or lumbar region, in the direction of the rectum and groin. Pain during ovarian apoplexy is of different nature: persistent or aggressive, stabbing or contracting. The pain attack lasts from 30 minutes to several hours, repeated several times during the day.
Bleeding during ovarian apoplexy is accompanied by a decrease in blood pressure, increased and weakening of the pulse, pale skin, general weakness, dizziness, fever, “heart failure”, dryness of the oral mucosa, vomiting, urination. Bloody discharge from the vagina is sometimes observed after menstruation.
Bleeding in the abdomen can pose a serious threat to a patient’s life if proper care is not provided.
Diagnostics and treatment
Diagnosis is based on a general examination of the patient, puncture of the posterior arch of the vagina, ultrasound examination of the small pelvis, and laparoscopy.
Treatment of ovarian apoplexy includes urgent surgical intervention by organ-sparing or radical methods. In the absence of timely care and complications (peritonitis, cures) the prognosis is reliable for life and future pregnancy. However, significant blood loss can lead to hemorrhagic shock, even a lethal outcome due to delayed and inadequate care!