gap ovarian cysts
gap ovarian cysts - a violation of the integrity of ovarian cysts followed by hemorrhage and the flow of blood into the pelvic cavity.Rupture of ovarian cysts observed in 1 - 2.5% of patients and refers to a group of acute gynecological pathology, requiring emergency surgery.Rupture can occur at any phase of the cycle, but the largest number of cases of rupture of an ovarian cyst is in the middle and second half of the cycle.
ovarian cyst is considered benign, it has a kind of light-filled with liquid and semi-liquid contents occasionally, bladder, surrounded by a capsule.Ovarian Cysts vary in size and structure, may be single or multiple, one-sheet or multi-chamber, they are often detected in both ovaries at the same time.
Ovarian cysts are not rare, they are diagnosed at any age, often in 20-35 years.
formation of cysts in the ovaries is closely connected with their structure and functions.The ovary is the most important female reproductive gland, and performs three t
1. childbearing (generative).With the ability to "grow" the ovaries provided the egg women to motherhood.
2. vegetative, allowing the girl to become a woman on the outside, and gender.
3. Hormone.The ovaries are produced estrogen and progesterone (a hormone of the corpus luteum).The secretion of sex steroids controls the pituitary gland.Hormonal ovarian function is closely associated with the activities of other endocrine glands, it provides normal hormonal regulation of basic life processes.
ovary has a solid shell underneath is the stroma, called cortical area.It contains a large number of follicles at different stages of maturation.Each follicle consists of the egg and its surrounding shell.A mature follicle is similar to the bubble is not more than 20 mm in diameter, filled with liquid.For one menstrual cycle in the ovary often ripen one egg.Once it reaches the maximum degree of maturity, the follicle wall breaks, releasing the egg outside the ovary.This moment coincides with the middle of the cycle and is called ovulation.After opening of the follicle is sleeping shell of its cells begins to form the corpus luteum acting as a temporary gland.If pregnancy occurs, the corpus luteum develops, strengthens its hormonal function and helps the body maintain a pregnancy in the first four months.After two weeks in the absence of fertilization it dies.
most common sources of the formation of ovarian cysts are follicles.Follicular cysts form when the follicle does not rupture, and starts to accumulate in their own oral liquid and grow.Ovulation in these cysts is not happening.
luteum cysts appear less follicular.Their development begins after ovulation, when disrupted the formation of the corpus luteum, and instead there is a small fluid-filled formation, surrounded by a capsule.
follicular and corpus luteum cysts are functional ovarian cysts hormonal nature and not considered as a disease.However, sometimes these cysts start to grow in size, might break the capsule of ovarian cysts followed by acute clinical manifestations.
In endometriosis and ovarian cysts are formed.The wall of the cyst is lined by cells identical to endometrium, they cyclically emit a small amount of thick dark blood in a cystic cavity, so the gap endometrioid ovarian cyst is accompanied by the release of characteristic color content, due to which these cysts are called "chocolate."
The ovary contains a large amount of blood vessels, so when the cyst ruptures, bleeding occurs with the formation of a hematoma (blood chamber).When the walls are destroyed hematoma, blood flows into the cavity surrounding the ovary.The right ovary is better supplied with blood, so the gap left ovarian cyst is less common.
Clinically capsule rupture of ovarian cysts depends on the amount of blood that falls outside of the ovary.Sometimes it slightly, and the symptoms are not expressed clearly.If the blood loss is large, there are signs of acute surgical pathology.
diagnosis of ovarian cyst rupture is similar to the diagnosis in case of emergency and should occupy a minimum amount of time.The most reliable and popular medical diagnostic method is laparoscopy.
Treatment cyst rupture is always surgical.Despite the desire to preserve the ovary during surgery, it is often necessary to remove.
reasons rupture of ovarian cysts
rupture of ovarian cysts sometimes diagnosed in perfectly healthy patients, and even after a detailed examination of its true cause can not be identified.However, in most cases, cysts rupture occurs with the participation of one or a group of the following triggering factors:
- Change the normal parameters of intra-abdominal pressure during excessive exercise, especially during menstruation or after.Inadequate power loads at the gym, riding, weight lifting, violent sexual intercourse and other similar circumstances often lead to the rupture of an ovarian cyst.
- Pathological changes in the vessel walls of the ovary.Sclerosis of the vessel wall makes it fragile and thin, and varicose prevents normal blood flow.
- Injuries to the abdomen.
- Inflammatory structural changes in the tissues of the ovaries.Against the background of ovarian tissue inflammation become loose and blood vessels lose their elasticity.In such circumstances, the ovary can be easily damaged.
- hormonal dysfunction.In the absence of a full ovulation follicle begins to accumulate fluid and increase, and then there is a rupture of follicular ovarian cysts and being around blood vessels.
If ovulation has occurred, a similar process may occur in the cavity of the corpus luteum.
- less common endometrioid cyst rupture is also associated with hormonal processes: under the influence of cyclical changes cysts allocates blood, it builds up in the cystic cavity, expands and breaks it.
- Long-term use of drugs that affect blood clotting (anticoagulants).
happen rupture cyst corpus luteum of the ovary during pregnancy has similar causes.
Symptoms of ovarian cyst rupture
quantitative advantage of all ovarian cysts belongs follicular cysts, the second place is occupied by the corpus luteum cyst.However, such statistics are not very reliable, as functional cysts can be asymptomatic for a long time, and pass on their own.
Since follicular cysts and corpus luteum cysts, there is more, and cases of rupture of these cysts can also be found anymore.More common rupture cyst of the right ovary is associated with a better blood supply to the right side of the pelvic region.
primary diagnosis of ovarian cyst rupture, usually performed by doctors "ambulance."Unfortunately, a reliable diagnosis is only 5% of cases, as the patient's condition is similar to that in any acute surgical pathology, and most of them are in the surgical department.Often, the right ovary cyst rupture confused with acute appendicitis, and the gap left ovarian cyst hospital simulates perforation of stomach ulcers.
A careful study of patient complaints can be related to the onset of symptoms to the menstrual cycle.Since follicular rupture of an ovarian cyst often occurs in the middle or second half of the cycle.
ovarian cyst rupture of any origin is always accompanied by two clinical signs - severe pain and internal bleeding.Severity of symptoms is determined by the amount of lost blood.
disease begins acutely with severe abdominal pain, or one of the iliac region, radiating to the waist, rectum, external genitalia.Sharp pain may be accompanied by nausea and vomiting, heart palpitations.
Amid massive blood loss anemia.The skin of the patient becomes pale, appears dizziness, weakness and hypotonia.Without emergency develops a picture of hemorrhagic shock.
usually the corpus luteum cyst rupture is not accompanied by severe abdominal pain, as these cysts rarely reach large sizes.Therefore leading place symptoms associated with internal bleeding.
During gynecological examination revealed tenderness on the side of the damaged cyst.In the vagina may be a small amount of bloody content.
When expressed bleeding blood accumulates in the pelvic cavity and flows down, which is why under the weight of her vaginal vault begin to loom, it can be clearly seen during the inspection, and is an important diagnostic feature, indicating the presence of blood in the abdomen.
On palpation determined by painful enlargement of the ovaries.Attempts to shift the cervix cause pain.
condition of the patient with rupture of an ovarian cyst does not allow for a long diagnostic search.The sooner the diagnosis, the more successful the treatment will be.
quickly and reliable method of diagnosis and subsequent treatment is laparoscopy.It allows you to see the entire pelvic cavity, to assess the degree of blood loss, to identify comorbidities.
rupture of ovarian cysts is not always the characteristics of emergency conditions, if the cyst is small, and blood loss during her break insignificant.In such a situation diagnosis is carried out outside the hospital.During ultrasound examination revealed an ovarian cyst with signs of hemorrhage and availability of blood in the pelvic cavity.
consequences of rupture of ovarian cysts
ovarian cyst rupture provokes the development of early and late complications.Early consequences are developed directly during surgery or in the postoperative period.
most dangerous, life-threatening complication is injury ovarian hemorrhagic shock on the background of the extensive blood loss.If the patient is not provided timely quality care, she may die.
During the operation, surgeons try to preserve the ovary, but unfortunately, it is not always possible, and the injured ovary removed.
Early complications after surgery can be prevented.For this restorative treatment is carried out after the rupture of an ovarian cyst, and surgery.
to remote negative consequences include cysts rupture:
- Adhesive process.During the surgery is not always possible to eliminate all izlivshuyusya blood.Over time, it becomes a source of adhesion formation.
- Infertility.Even in the case of the removal of one ovary patient is not deprived of the possibility of getting pregnant.However, this is only possible in the normal menstrual cycle and in the absence of postoperative infectious complications.
- Ectopic pregnancy.The presence of adhesions alters the normal location of the fallopian tubes.Instead of descending into the uterus, the egg is literally stuck in the pipe, and starts to form an ectopic pregnancy.
- Recurrent ovarian cyst rupture.Repeated trauma happens against the backdrop of ovarian hormonal and vascular causes, not liquidated earlier.
most frequent cause of fracture functional ovarian cysts are hormonal disorders.Therefore, rehabilitation treatment after rupture of an ovarian cyst should always include correction of existing hormonal dysfunction.
Surgery for ovarian cysts rupture
Some patients in the dimly expressed signs of rupture of ovarian cysts underestimate the seriousness of the situation and did not agree to the operation.Conservative treatment of mild forms of ovarian cyst rupture in almost 86% of cases leads to the development of adhesions, and in 43% of provoking infertility.Among the previous conservative therapy patients every second Relapse.
Surgical treatment after rupture of an ovarian cyst is the most reliable way to quickly eliminate the process threatens the health and prevent complications.Preference is given to laparoscopically.
As a rule, pre-determine exactly how the operation will take place, is problematic.The decision is made after a thorough inspection of the damaged ovary and surrounding structures.
Regardless of the chosen tactic held:
- Stop the bleeding.Usually bleeding sites coagulate (cauterize) or produced ligation of the damaged vessel.
- Restoring the integrity of the ovary.The possibility to maintain authority decides, after visual inspection.Sometimes, at the time of inspection in the ovary is a cyst, it is opened and the contents removed.The remaining wound is sutured.
If there is extensive damage to the site made resection of the ovary: the damaged tissue is cut out and the remaining ovary sutured.
Irreversible changes in the ovary do not allow to preserve its integrity, then held adnexectomy - oophorectomy.
- Elimination streamed blood.The blood in the pelvic cavity can be a source of inflammation and trigger the development of adhesions.Therefore, during the operation carried out thorough washing of all adjacent to the ovary tissues and organs, and blood "washed out."
After laparoscopy recovery takes a week, then the patient returns to normal life.