gap ovarian - a spontaneous violation of the integrity of the shell of the ovary, followed by internal bleeding.The physiological process of a small shell of the ovary damage happens every month in the middle of a two-phase of the menstrual cycle at all young women and not considered as a disease.Pathological ovarian gap belongs to the group of acute emergency conditions associated with internal bleeding and a threat of serious consequences.
Spontaneous rupture of ovarian pathology in women is associated with impairment of the formation of the physiological menstrual cycle, so often happens in not overcome the 35-year milestone of women in the middle or in the second half.Pregnancy does not exclude ovarian rupture.
damage the outside of the ovary is almost impossible, since its tissue (cortex) protects dense albuginea.Therefore, the gap always ovary in women is due to pathological processes in the underlying layer.
Under the tunica in the ovary is full of primordial follicles
After the eggs on the surface of the ovary, a small wound surface, and in the pelvic cavity leaves a little blood, which causes a small abdominal pain in women at mid-cycle.Of violations quickly eliminated by the body at the expense of internal resources: the wound heals quickly on the ovary, and blood came out resolved.At the site of the ruptured follicle cells from its shell begins to form a temporary hormonal glands - the corpus luteum.It is responsible for the synthesis of progesterone and is necessary for normal development of a potential pregnancy, and if fertilization does not occur, the corpus luteum undergoes regression.
All structural and functional processes in tissues ovary cyclic hormonal changes are accompanied and controlled by the pituitary gland: follicle stimulating hormone (FSH) in the first phase of the cycle, and luteinizing hormone (LH) in the second.
source of bleeding at rupture of ovarian follicles is almost always or yellow body.However, the physiological rupture of the follicle of the ovary during ovulation is not seen as pathology.
Right departments pelvic organs are supplied with blood better than the left, so the gap left ovary is less common.
clinical signs of rupture of the ovary depends on the volume of blood loss.Minor bleeding is accompanied by symptoms of dull, but in most cases the disease begins suddenly and sharply, rapidly acquiring traits of emergency conditions.
Put a primary diagnosis of ovarian gap on the basis of the clinical picture can be achieved only in 4-5% of cases, as the complaints of patients correspond to those of any acute surgical pathology.
Conservative treatment of ovarian rupture is possible in the case of minor bleeding, but after developing a large number of complications, and recurrence often happens.
reasons gap ovarian
The largest number of cases of ovarian rupture is necessary at the time of ovulation or the corpus luteum formation stage, when the ovarian tissue is most vulnerable, easily injured and sprouting new blood vessels.The source of the bleeding vessels are follicle or yellow body.
When a vessel in the ovary is damaged, the blood comes out and forms a hematoma.If bleeding continues, hematoma increases, pushing from the inside to the capsule of the ovary, breaks it and pours into the pelvic cavity.Often there is a rupture of the right ovary.Pregnant source of internal bleeding is the gap of the corpus luteum of the ovary in the early stages.
Sometimes ovarian rupture diagnosed in healthy women without obvious reasons, so to speak of the presence of precipitating factors of its appearance.These include:
- Events, accompanied by increased intra-abdominal pressure.Excessive exercise, riding, weight lifting, incorrect dosage fitness load or too rapid sexual intercourse often provoke bleeding in the ovary.
- adhesions in the pelvic area.
- infectious-inflammatory process in the tissues of the ovary.Under the influence of inflammation of the walls of vessels become fragile, and the stroma of the ovary is loosened.
- abdominal injury.
- State, accompanied by a decrease in blood clotting, including receiving anticoagulants.
- pituitary dysfunction.Violations must secretion "controlling" hormones leads to structural abnormalities in the ovaries.
- vascular pathology of the ovary.Thinning, sclerosis, or varicose vascular wall lead to a breach of its elasticity and prevent the normal circulation of the blood vessel and it pererastyagivaet provokes break.
Pregnant rupture of the corpus luteum of the ovary and cause the above reasons.
most vulnerable periods of development in the ovary is bleeding ovulation and corpus luteum vascularization stage, when the ovarian tissue is present the largest number of vessels.
often precedes the formation of ovarian rupture so-called functional cysts.When hormonal disorders instead of ovulation is the process of accumulation of fluid in the follicle, it increases and creates follicular cysts that can rupture with the surrounding blood vessels.
Sometimes hormonal dysfunction can affect the process of formation of the corpus luteum.In this case, ovulation normally occurs in the ovary, but instead begins to form the corpus luteum cyst, which is similar to follicular may increase and rupture, causing internal bleeding.
functional cysts in the ovarian tissue is often diagnosed during ultrasound.They are not considered disease and can pass on their own.The exception is a situation where on the background of hormonal disorders, these cysts start to grow, then the capsule may occur cyst rupture and subsequent bleeding.
Symptoms of ovarian rupture
As a rule, primary diagnosis of ovarian rupture spend doctors of "first aid".Rupture of the ovary is characterized by two major clinical symptoms - severe pain and internal bleeding.
first signs of rupture of the ovary appear suddenly on the background of well-being.Begin sharp abdominal pain in the projection of a damaged ovary, radiating to the back, external genitalia or rectum.Intense pain can be combined with vomiting, vomiting and heart palpitations.A careful survey of the patient can be related to the appearance of pain with the menstrual cycle.Often accompanied by a slight gap ovary vaginal bleeding.
Symptoms of ovarian rupture similar to symptoms of acute surgical pathology and have distinctive features.Thus, the gap of the right ovary has signs of acute appendicitis, and the gap left ovary in the primary stage of diagnosis is difficult to distinguish from a stomach ulcer perforation.Therefore, patients often find themselves in the surgical department.
severity of the general condition of the patient is determined by the volume of lost blood.According to the blood loss are the following clinical forms:
- light (100 - 150 ml);
- average (500 ml);
- heavy (over 500 ml).
signs of internal bleeding are pale skin, low blood pressure, rapid pulse, dizziness, cold sweats, and severe weakness.A large blood loss is dangerous development of shock.
During the inspection determined by tenderness anterior abdominal wall, and the presence of blood in the abdomen indicate symptoms of peritoneal irritation.
compulsory gynecological examination suggests the presence of blood in the pelvic cavity: it flows from the ovary down and accumulates in the area bordering with the vaginal vault.During the inspection of the vaults of the vagina hanging.If this situation is conducted diagnostic puncture pelvic area through bulging vaginal vault in punctate blood appears.
On palpation the uterus remains firm and painless cervical displacement in the direction causes a sharp pain, but on the side of the injury is determined by the enlarged, painful ovaries.
gap ovary must be diagnosed quickly, as the patient's condition deteriorates drastically and quickly.The most reliable diagnostic method is laparoscopy, which allows to explore the whole pelvic cavity, to assess the degree of blood loss and determine the amount of treatment.With an accuracy of 98% laparoscopy can quickly make the correct diagnosis and surgical treatment at the same time produce a rupture of the ovary.
consequences of rupture of ovarian
Any break in the ovary leads to negative consequences, but timely diagnosis and proper treatment to help them to eliminate or reduce to a minimum.
most dangerous, life-threatening complication of ovarian rupture is considered to be hemorrhagic shock due to severe blood loss.The faster a patient hospitalized in a hospital, the less the likelihood of a negative outcome.Therefore, it is essential that at the first sign of trouble the patient asked for help.
unacceptable attempt self-medication treatment had symptoms of ovarian injury.Medication against pain and spasm facilitate health, creating the impression of improvement, but this time the internal bleeding continues and worsens the patient's condition.
largest number of negative effects observed in attempts of conservative treatment of mild ovarian rupture.
During surgery is sometimes due to extensive damage to the tissues of the ovary it must be removed.So often women who have undergone surgery, are concerned about whether it is possible pregnancy after ovarian rupture and remove it.Infertility after trauma ovary does not develop if the second ovary healthy and patient persists biphasic ovulatory cycle.
long-term adverse effects of trauma are associated with ovarian complications after surgery.In the process of internal bleeding in the pelvic cavity accumulates blood.During the operation, try to eliminate it, but sometimes, when extensive blood loss, this can not be done.Over time, it can cause inflammation in the epididymis, and yet it is organized and becomes a source of formation of adhesions.
Ectopic pregnancy after breaking the ovary is associated with inflammatory changes and adhesions in the pelvic area.
If treatment is not carried eliminates hormonal dysfunction and vascular pathology, rupture of the ovary may be repeated.
operation at break ovarian
without prior visual inspection of the damaged ovary and surrounding area to determine the volume of surgery is not easy.
detailed treatment plan is formed only in the process of diagnostic laparoscopy.Taking into account:
- The degree of damage to ovarian tissue.Having a small gap on the background of an unchanged ovarian tissue can be sutured, and a large hematoma in the ovary requires the removal of the damaged area and then restore the integrity of the rest of the body.Removal of the ovary is called a resection.
If ovarian cysts detected, the contents completely evacuated, and the ovary is sutured.
Extensive damage to the ovary does not allow him to keep, held adnexectomy - oophorectomy.
- The character of blood loss.All bleeding vessels "cauterize" or a bandage, and accumulated outside the ovary blood "washed out" with special solutions.
- Inspection of adjacent organs and tissues.Be sure to conduct inspection of the second ovary and both fallopian tubes.If the second ovary has a cyst, it eliminate identified dissect adhesions, and found pockets of endometrial removed.
After the operation carried out by all means prevention of complications: anti-bacterial and anti-inflammatory treatment, eliminated anemia.
Recovery postoperative period not exceeding seven days, and then the patient leaves the hospital.However, the operation is not the final stage in the treatment of ovarian rupture, because it eliminates the effects and not the cause of the break.Since then the correction of existing hormonal disorders and elimination of vascular disease.