Ovary apoplexy, or rupture of an ovary, this acute state arising owing to sudden disturbance of integrity of tissue of ovary, which is followed by intra belly bleeding and a pain syndrome. The apoplexy of an ovary occurs at women of reproductive age, is the most frequent in an age group from 25 to 40 years. The ovary apoplexy on the right side occurs several times more often than with left that is connected with stronger krovenapolneniye of the right ovarian artery owing to anatomic features.
Always disturbances in vessels and tissues of an ovary, as a rule, formed owing to chronic inflammatory process are a proximate cause of an apoplexy of an ovary. The changed tissues both the ovary, and vessels, feeding (a sclerosis, cicatricial changes, a varicosity) result it in the increased risk of a gap. In certain days of a menstrual cycle (the middle and the second phase of a cycle) load of vessels increases that in combination with pathological changes and provocative factors serves as the ovary apoplexy reason.
Factors which can serve as the additional reason of an apoplexy of an ovary are:
All above-mentioned paves the way in order that there was an ovary apoplexy. When there is a combination of similar factors to pathological changes of vessels and the ovary, any physical effort which caused a stomach muscle tension can become a last straw, the external reason of an apoplexy of an ovary. As such effort often serves rough sexual intercourse (most often), sports activities, riding, etc. In certain cases the apoplexy of an ovary can spontaneously occur, during absolute rest.
Depending on expressiveness of these or those symptoms, the apoplexy of ovaries is divided into the following forms:
It is necessary to consider that division it is rather conditional and superficial as hemorrhage occurs not only at hemorrhagic, but also at a painful form of an apoplexy of an ovary. In this regard, classification of apoplexies of an ovary depending on blood loss size is accepted now. So, allocate the following forms of an apoplexy of an ovary:
Lack of this classification is that blood loss usually exact quantitatively can be established already only directly during an operative measure.
The main symptom of an apoplexy of an ovary is acute sudden pain in the lower part of a stomach from defeat. The megalgia, can be followed by nausea and even vomiting. At a painful form of an apoplexy of an ovary pain usually does not irradiate, concentrating in the field of defeat. Blood loss signs in this case are poorly expressed that very complicates diagnosis.
For a hemorrhagic (anemic) form the megalgia is not inherent though the pain syndrome can be also present, in less expressed form, than at a painful apoplexy of an ovary. However in this case pain has the irradiating character, that is is given to a waist, a sacrum, a rectum and even external genitals. Anemia symptoms become the main symptoms of an apoplexy of an ovary in this case: pallor of integuments, cyanosis of lips and nails, weakness, short wind, dizziness and faints.
At the mixed ovary apoplexy form the symptoms characteristic of painful and anemic forms will be combined: severe pain from the affected ovary against the background of anemia.
As it was already mentioned, diagnosis of an apoplexy of an ovary represents considerable difficulties, because of not specificity of symptoms. The patient shows the complaints characteristic of an acute abdomen generally, or on suddenly come anemia. It can sometimes be informative ultrasonography, also at suspicion on an apoplexy of an ovary carry out a puncture of a back vault of the vagina, a diagnostic character is availability of free blood in this area. The laparoscopy – an endoscopic research of an abdominal cavity remains only the most reliable and faultless diagnostic method in this case. The laparoscopy in case of an apoplexy of an ovary is both a diagnostic, and medical method.
Treatment of an apoplexy of an ovary has to be urgent as this life-threatening state. If blood loss is not stopped, and will reach the considerable sizes, the lethal outcome can even be an effect of an apoplexy of an ovary. Besides, the peritonitis which developed as a result of impact of blood on a peritoneum that also threatens life can become an effect of an apoplexy of an ovary also.
Earlier was considered that treatment of an apoplexy of an ovary can be both conservative, and surgical. The indication for conservative treatment of an apoplexy of an ovary it was considered to be a painful form, with insignificant blood loss. However as a result of long-term practical observations it was established that conservative treatment of an apoplexy of ovaries even in case of insignificant bleeding has the adverse remote effects. The blood which streamed in belly space, even in small amounts is the active environment causing an aseptic (amicrobic) inflammation. In the place of an inflammation the commissures breaking a normal structure of both the ovary, and surrounding structures are formed. An ovary apoplexy effect in this case very often is infertility.
Thus, the most adequate method of treatment of an apoplexy of an ovary is surgical intervention which in most cases (except the most severe forms of a disease) is carried out in the laparoscopic way. Medical tactics in this case consists of an abdominal cavity of the streamed blood and washing by its solutions of antiseptic agents, if necessary sewing up of the damaged vessel at a distance. In the postoperative period carry out the complex drug treatment of an apoplexy of an ovary directed to elimination of the reasons which caused pathology: normalization of exchange and hormonal processes, elimination of a chronic inflammation, etc.
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