What is Ovarian Apoplexy?
Ovarian apoplexy is a rather rare pathology in which there is a sudden rupture of the wall of the cyst or ovarian follicle through which the blood vessel passes. This can cause bleeding. The volume of blood loss can range from minor to critical. In the latter case, death may occur without timely diagnosis and surgical treatment. Ovarian apoplexy constitutes approximately 5-10% of acute gynecological pathologies.
According to the main symptoms, the pathology resembles an ectopic pregnancy , appendicitis attack or ovarian torsion. There is pain that can be unbearable and unbearable, sometimes throbbing or aching. Often, emergency surgery is required to stop the bleeding. If the diagnosis is delayed or incorrect, the prognosis for the patient’s life may be markedly worse.
Causes of ovarian apoplexy
Reliable causes of ovarian apoplexy have not been established. There are women who encounter pathology with bleeding of varying severity 2-3 times a year, while in other women it happens once in a lifetime or not at all. Apoplexy is possible in the presence of a cyst in the ovary due to mechanical reasons such as lifting heavy objects, abdominal trauma, contact sports, and intense sexuality. Such problems are especially dangerous in the middle of the cycle and in the zone of spawning in the second stage. Factors aggravating the course of apoplexy are taking drugs that thin the blood (anticoagulants, antiaggregants) at the beginning of the pathology. More often for some reason the right ovary suffers. The age group is young girls and women of reproductive age, where follicle formation is most active.
Symptoms of ovarian apoplexy
Based on the predominance of certain symptoms, it is customary to distinguish three forms of pathology. These;
- Hemorrhagic: signs of blood loss predominate,
- Painful: Intense painful sensations dominate,
- Mixed: Both blood loss and pain syndrome symptoms are evident.
The severity of the condition is determined by the amount of blood lost, but ultrasound evaluation is usually approximate. It can be defined as follows. These;
- Easy blood loss: up to 150 ml of blood,
- Medium: up to 500 ml of blood,
- Heavy: Anything over 500 ml, usually blood.
Pain occurs because blood irritates the peritoneum, which contains many pain receptors, the amount of pain is not always directly dependent on the blood volume in the pelvis or abdomen. With right-sided apoplexy, the pain is often mistaken for an attack of appendicitis, in which fluid can accumulate in the pelvis and can be mistaken for blood on ultrasound. Signs of blood loss during apoplexy (but not only with it) are dizziness, weakness, pallor of the skin and mucous membranes, sweating, nausea and vomiting. Sometimes due to blood pressure in the bladder or intestines (there must be a lot of blood), false urges to urinate or defecate may occur. If the blood is already in the upper abdomen, there may be an unpleasant sensation in the shoulders and neck (symptom of phrenicus). Frequent urination occurs, urge every hour or more often.
Diagnosis of ovarian apoplexy
The diagnosis is made by a gynecologist on the basis of typical complaints and anamnesis data, examination, assessment of pulse and pressure, ultrasound of the pelvis and abdomen, blood tests and if pregnancy is excluded (a urine pregnancy test is sufficient). An experienced gynecologist in real life can usually diagnose in 5 minutes. The definitive diagnosis is made laparoscopically, during the operation the source of the bleeding is determined and at the same time it stops. Only in rare cases, when the volume of blood loss is critical and it is necessary to stop the bleeding as quickly as possible, do they resort to abdominal surgery.
How is ovarian apoplexy treated?
For mild to moderate bleeding, conservative treatment is possible under the constant supervision of a doctor in the hospital, if there are no signs of ongoing blood loss. It provides a dynamic assessment of the level of hemoglobin in the blood and serial ultrasound to exclude the progression of blood loss. Hemostatic drugs are often used, sometimes iron preparations are prescribed. Strict bed rest, as well as the use of vitamins, electrophoresis, physiotherapy to prevent adhesions, have long been considered archaic and have no evidence base.
During the operation, laparoscopy is performed, blood is drawn, the source of the bleeding is found, stopped, sometimes the cyst is removed at the same time. If the blood loss is large, the collected blood is usually passed through a special filter system, cleaned, concentrated and disinfected, after which the patient’s own blood is returned to the vein. The system is called CellSaver and is used in large modern medical centers.