Acute Complications (ruptured ovarian cyst, torsion of ovarian cyst)

What is a ruptured ovarian cyst?

Ruptured ovarian cysts are the most common cause of acute pain in the pelvic region in women during the premenopausal stages. The sonographic appearance of the ruptured cyst depends on the cyst being a hemorrhagic or straightforward despite having collapsed completely.

Pathology 

Although ruptured ovarian follicle is a physiological event, it may cause dramatic clinical symptoms. The ruptured ovarian cyst may cause pain from stretching the capsule from the ovary, leakage of cyst content or torquing of the ovarian pedicle which leads to peritoneal irritation.

 

Causes 

  • Constipation: Bowel movement straining puts pressure on the cyst and consequently rupture
  • Anti-coagulation therapy: Women who take anticoagulants or those of clotting factor deficiency have the risk of ruptured corpus luteum due to coagulation abnormalities
  • Sexual intercourse: Right after sex large cysts can burst and cause rupture
  • Pregnancy: Ruptured ovarian cyst may develop during pregnancy
  • Trauma
  • Hormonal fluctuations: Menstrual cycle and hormonal changes
  • Sudden movement while playing sport, exercise and even during bending

Symptoms 

  • Bleeding
  • Pressure on abdomen and distention
  • Excessive abdominal pain
  • Dizziness
  • Nausea or vomiting
  • Low-grade fever

Diagnosis 

The determination of the ruptured ovarian cyst is done with ultrasonography and if the test is not clear, then doctors may prescribe undergoing pregnancy test to rule out ectopic pregnancy.

Treatment 

No treatment is required if the ovarian cyst has ruptured assuming a woman’s vitals and blood counts are stable. Sometimes to manage the discomfort, pain medications are given to the patient and will be advised to take rest until the fluid of the cyst gets reabsorbed by the body and its symptoms go away. Surgical intervention may be required if a woman continues to bleed or the bleeding is heavy.

Torsion of Ovarian Cyst

What is Torsion of Ovarian Cyst?

Ovarian torsion, also known as tube-ovarian torsion or adnexal torsion refers to the twisting of the ovary and a portion of the fallopian tube during the supply of the vascular pedicle.

Pathology of Ovarian Torsion

The ovarian torsion causes necrosis and hemorrhagic infarction which can occur as quickly as within hours of torsion onset. Ovarian torsion occurs more commonly in young children with developmental abnormalities such as the absence of mesosalpinx or excessively long Fallopian tube.

Causes of Ovarian Cyst Torsion

Torsion occurs only when the ovary is unstable, but it has other reasons even.

  • During pregnancy
  • Having long ovarian ligament
  • Infertility
  • Polycystic ovarian syndrome
  • Had a tubal ligation

Symptoms of Ovarian Torsion

The symptoms of ovarian torsion are-

  • Nausea
  • Vomiting
  • Cramping
  • Severe pain in the lower abdomen

Diagnosis of Ovarian Torsion

Ovarian torsion requires immediate medical attention but if treated lately might cause severe complications. After going through the symptoms, doctors may ask the patient to have-

  • Transvaginal ultrasound to view the fallopian tube, ovary and blood flow
  • Blood tests
  • Ovarian abscess
  • Appendicitis
  • Ectopic pregnancy

Treatment for Ovarian Cyst Torsion

To untwist the ovary, surgery is required and maybe for the fallopian tube also.

Surgical Procedure

  • Laparotomy: with the help of general anesthesia a large incision is done in the lower abdomen which allows reaching the location and untwisting the ovary manually and the patient is supposed to stay at the hospital overnight.
  • Laparoscopy: a lighted, slender instrument is inserted through a small incision in the lower abdomen, and this allows the doctor to view the internal organs. Another incision is made to access the ovary and once it is located then with the help of a blunt probe or the tools the ovary is untwisted.

If there is a prolonged blood flow, then the surrounding tissues may die which requires removal of the organs with the following two procedures-

  • Salpingo-oophorectomy- when both the fallopian tube and the ovaries are no longer viable, then both of them has to be removed through a laparoscopic process. This procedure is also recommended to avoid the recurrence in a postmenopausal
  • Oophorectomy- the ovary is removed through laparoscopic procedure if the ovarian tissue is no longer viable.

Medication

After the removal, the doctors may prescribe some pain relievers for recovery. They are-

  • Naproxen (Aleve)
  • Ibuprofen (Advil)
  • Acetaminophen (Tylenol)

If the pain is severe, then the following medicines can be taken-

  • Oxycodone with acetaminophen (Percocet)
  • Oxycodone (OxyContin)

To reduce the chance of re-growth doctors may suggest a high dose of birth control pills or other forms of hormonal birth control.

Complications of Ovarian Cyst Torsion

If the diagnosis and treatment take a long time, then the rate of torsion of the ovarian cyst increases. When there is a reduction in blood flow in the ovary and possibly in the fallopian tube then torsion occurs which leads to tissue death (necrosis). If this is the case, then doctors remove the ovary and the adjacent and affected tissue. To seek medical attention is the only way to avoid many complications. However, ovarian torsion does not affect the fertility of a woman, that is, pregnancy and conception are still possible if one is removed.

References

  • https://radiopaedia.org/articles/ruptured-ovarian-cyst
  • http://drgavinsacks.com.au/2017/01/ovarian-cyst-rupture-symptoms-and-causes/
  • https://www.verywell.com/what-happens-if-i-have-a-ruptured-ovarian-cyst-2616648
  • https://radiopaedia.org/articles/ovarian-torsion
  • https://www.healthline.com/health/womens-health/ovarian-torsion#causes-and-risk-factors

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