A rupture or apoplexy of the ovary is a pathological violation of the integrity of the ovary and its vessels, in which bleeding is formed inside the abdominal cavity and there is pain in the abdomen. During ovulation, an ovary ruptures in the follicle area, it is a physiological phenomenon, it is not accompanied by pain and bleeding. As a result of pathological changes in the body, apoplexy is formed.
The exact reasons why an ovary rupture occurs are not established today. Most often there is apoplexy at the age of 20 to 35 years.
The main theory of the formation of ovarian rupture is considered neuro-endocrine changes in the processes of regulation of ovulation. Due to the cyclical release of hormones, the blood filling of the ovarian area and the process of follicle release are regulated. If this process fails, pathological ruptures may occur with vascular damage and bleeding.
Importance is given to inflammatory processes in the pelvic area, ovarian developmental abnormalities, and tumor processes. Impact and external influences – weightlifting or injury of the lower abdomen, violent sex.
For the most part, ovarian rupture occurs at the stage of ovulation or later, in the second phase of the cycle. Apoplexy occurs much more frequently in the area of the right ovary due to the anatomical features of its blood supply.
Symptoms of a ruptured ovary can simulate ectopic pregnancy. Apoplexy usually occurs abruptly, against the background of a completely normal state of health, more often in the evening or at night.
When ovarian rupture is characterized by sharp paroxysmal abdominal pain, localized on the right, less often on the left. Occasionally, tingling pains in the groin area on the right or on the left may precede an attack.
Pain can be:
- paroxysmal throughout the time
- may begin with a seizure in the side, moving to the lower back, perineum, and then become blurred in this abdomen.
As blood accumulates in the abdominal cavity, symptoms of peritoneal irritation are detected:
- soreness when feeling the abdomen,
- small bleeding from the vagina,
- tension of the abdominal wall closer to the affected area,
- pallor is formed,
- heart palpitations
- decrease in pressure, fainting,
- tinnitus, nausea, dizziness.
- occasionally a rise in temperature.
It is necessary to distinguish the gap of the ovary from appendicitis and ectopic pregnancy, but often the final verdict is already made during the operation.
Tactics of treatment of ovarian ruptures depends on the degree of blood loss and the intensity of bleeding. With mild severity, many doctors choose conservative patient management tactics — strict bed rest, cold on the stomach, and complete rest with hemoglobin control, hematocrit, and general condition are recommended.
With moderate and severe tears, an operation is performed with simultaneous infusion of blood-substituting solutions and plasma. During surgery, they try to minimize the amount of intervention – the ovary is resected with damaged vessels. If possible, laparoscopic surgery is performed without incisions, through the punctures of the abdominal cavity.
If necessary, extensive intervention and removal of blood from the abdominal cavity, conduct the lower-middle laparotomy with a thorough examination of the pelvic organs and the abdominal cavity. During the operation, surgeons focus on the situation – if the gap is formed on a healthy ovary, coagulation of the bleeding vessel and special sutures are performed. If cysts are found on the ovary, the volume of the operation expands.
The prognosis for ovarian ruptures is favorable, however, after discharge from the hospital, a detailed examination is necessary.