What is dangerous rupture of the ovarian follicular cyst. Signs of a ruptured ovarian cyst

Content

One of the most acute and dangerous conditions in gynecology is the rupture of an ovarian cyst. According to statistics, it occurs in approximately 15-17% of cases of gynecological pathologies. The severity of the patient's condition depends on the type of formation that caused the apoplexy. Familiarize yourself with the clinical picture of this pathology, the principles of treatment of cyst rupture, rehabilitation, prevention, and the consequences of such a condition for a woman.

What is a ruptured ovarian cyst

A pathological condition that is caused by a hemorrhage in the pelvic cavity, a violation of the formation capsule and the release of its contents is called apoplexy or cyst rupture. The disease is more common in girls in adolescence and in young women. The rupture of the cyst of the left ovary occurs several times less frequently than the right one. This is due to high blood pressure and intensive blood supply.

By the nature of cystic formations are divided into functional and organic. The first, as a rule, temporary, are formed due to a slight disruption of the ovaries and often go away on their own or after a short hormone therapy. Organic cysts require mandatory surgical intervention. There are the following types of cysts:

  1. Follicular. The formation cavity is single-chamber, has thin walls, the size rarely exceeds 5-7 cm in diameter. Rupture of such cysts occurs infrequently and usually does not require surgical intervention.
  2. Yellow cyst. It has thickened walls, in diameter it ranges from two to seven centimeters. Rupture of the corpus luteum is treated conservatively.
  3. Endometrioid. It is formed by the tissues of the inner lining of the uterine wall. The formation cavity is filled with a dark liquid. Apoplexy with an endometrioid cyst requires surgical treatment.
  4. Dermoid. This non-functional formation is a part of the embryonic germ sheets and connective tissue derivatives (teeth, fat, cartilage). Such a cyst does not reach a large size.

Causes

Apoplexy can occur in the presence of an ovarian cyst of any etiology and type. Rupture is more prone to functional cysts, which are formed in violation of the normal process of ovulation. Causes of apoplexy include:

  1. Violations of the functioning of the endocrine glands, imbalance of the hormones of the hypothalamus, pituitary gland, ovaries (impaired synthesis of luteinizing and follicle-stimulating hormones).
  2. Disorders nervous system caused by overwork, stress, excessive mental or physical stress.
  3. Inflammation of the pelvic organs, which leads to impaired blood supply to the ovaries, appendages, uterus, as well as fibrous and sclerotic tissue changes.
  4. Excessive rush of blood to the fallopian tubes and gonads.
  5. Benign and malignant neoplasms.
  6. Varicose veins of the pelvic organs, leading to stagnation of blood.
  7. Poor circulation caused by tumors, adhesions, etc.
  8. Abnormal structure or location of the ovaries, uterus.
  9. Abortion.
  10. Hormonal stimulation of the ovaries (for example, with IVF), long-term use of oral contraceptives.

Provoking factors include intense physical activity, intense sexual intercourse, abdominal trauma, and inaccurate vaginal examination. The rupture of the endometrioid cyst occurs, as a rule, with blood clotting disorders or with the uncontrolled use of certain medicines: anticoagulants, non-steroidal anti-inflammatory drugs.

Symptoms of a ruptured ovarian cyst

Signs of cyst rupture depend on the intensity of blood loss, the presence of concomitant gynecological diseases. The predominant symptoms are severe pain and bleeding. Associated features are:

  • bleeding from the vagina;
  • increased body temperature;
  • tachycardia;
  • muscle tension of the abdominal wall;
  • nausea, single vomiting;
  • dizziness, loss of consciousness;
  • lowering blood pressure;
  • physical weakness;
  • pallor of the skin.

Severity

Methods of treatment of this disease depend on the severity of the clinical picture. Ovarian apoplexy is divided into three degrees of severity, based on the patient's condition and the volume of blood loss:

  1. Easy degree. At the same time, the clinical picture of cyst rupture is expressed indirectly, and the pathology requires careful diagnosis and differentiation with other diseases (for example, appendicitis, renal colic). A mild degree, as a rule, does not require surgical treatment and is eliminated by conservative methods. Blood loss in this case is no more than 0.15 liters.
  2. Average degree. Blood loss is from 0.15 to 0.5 liters. The patient complains of pain of moderate intensity, weakness, spotting from the vagina. Moderate treatment includes hospitalization and emergency surgery.
  3. Severe degree. Free blood in the abdominal cavity is more than half a liter. For a severe degree, symptoms of hemorrhagic shock are characteristic: pallor of the skin, tachycardia, a sharp drop in blood pressure. The patient needs urgent hospitalization and surgical treatment. In the absence of timely treatment, a fatal outcome is possible.

Diagnostics

Ovarian cyst apoplexy may have a blurred clinical picture, so it is necessary to conduct a differential diagnosis with intestinal colic, gastrointestinal bleeding, inflammation of the appendix. First of all, it is necessary to examine the patient on the gynecological chair, determine the size of the internal genital organs, areas of pain. Then additional instrumental and laboratory studies are prescribed:

  1. Ultrasonography. With its help, the integrity of the pelvic organs, the presence of fluid in the abdominal cavity, its amount are determined.
  2. Puncture of the posterior fornix of the vagina. The study is performed on a chair without the use of anesthesia. The patient is injected with a needle through the back wall of the vagina and collect the contents of the abdominal cavity. The presence of blood in the punctate indicates apoplexy. The study may be uninformative when a dermoid cyst is ruptured.
  3. Clinical blood test. When the cyst ruptures, there is a decrease in the level of erythrocytes and hemoglobin, an increase in the number of leukocytes.

Treatment

Therapy of apoplexy directly depends on the type of damaged cyst, the severity of symptoms and blood loss. After making a diagnosis, conducting an examination, instrumental studies, the attending physician decides on the method of treatment. There are two types of treatment for cyst ruptures: conservative and surgical (laparoscopy or laparotomy). The exception is dermoid formations: their treatment requires immediate surgical intervention.

Treatment without surgery

This type of correction is used in the absence of a severe, life-threatening clinical picture. As a rule, conservative treatment is prescribed if there is a rupture of the follicular ovarian cyst or other functional formations. In this case, the patient is prescribed bed rest, a cold compress on the lower abdomen, and anti-inflammatory drugs. Analgesics and drugs that relax smooth muscles (antispasmodics) should not be used after the pain attack has been relieved, because. severe bleeding may occur.

After completing the main course of treatment, the patient is prescribed hormonal contraceptives for a period of 3-6 months to restore normal ovarian function. Conservative therapy for cyst rupture is carried out strictly in a hospital to monitor the dynamics of the patient's condition and provide emergency care in case of a sharp deterioration in the patient's condition.


Operation

If the walls of the cystic formation are damaged, its contents are poured out and the arteries and veins are damaged, immediate surgical intervention is often indicated. There are two types of surgical treatment for apoplexy: laparoscopy and laparotomy. The choice of the method of surgical intervention depends on the severity of the patient's condition, the presence of complications in the form of severe bleeding or peritonitis.

Laparotomy is open surgery. This means that the patient is made a horizontal or vertical incision in the lower abdomen. The advantage of this method of surgical intervention is given with a large volume of fluid in the abdominal cavity or peritonitis that has begun. The patient is placed under general anesthesia during laparotomy. During the operation, the doctor examines the damaged organs, performs a resection of the ovary. Then the abdominal cavity is cleared of contents and the abdominal wall is stitched in layers, leaving drainage.

After the operation, the woman should be on inpatient treatment at least a week. For the prevention of infectious processes, broad-spectrum antibiotic therapy is prescribed. In addition, bed rest is required, fractional diet food. Laparotomy has a number of disadvantages:

  • long postoperative period (from 2-3 weeks to several months);
  • high risk of infection of the surgical wound;
  • high probability of developing surgical bleeding and other complications;
  • possible development of postoperative pain.

Laparoscopy is a closed operation, which is performed using special instruments and optical instrument, the image from which is displayed on the monitor. In this case, three holes are made in the abdominal wall: one for a camera with a flashlight and two for tools (manipulators). Laparoscopy is performed under general anesthesia. The doctor carefully dissects the damaged ovary and cleans the abdominal cavity. After carrying out the necessary manipulations, sutures and a sterile bandage are applied to the holes in the abdominal cavity.

After the laparoscopy, the patient is observed in the hospital for 3-5 days, then (in the absence of complications) they are discharged for outpatient treatment. Reception of anti-inflammatory, antibacterial pharmacological preparations, vitamins and immunomodulators is shown. Among the main advantages of such an operation, there is a quick recovery and a low risk of additional complications. The disadvantages of laparoscopy are:

  • limited area for manipulations of the surgeon;
  • the need for expensive equipment and special skills of the doctor;
  • the inability to accurately determine certain characteristics of organs;
  • limited visualization;
  • the impossibility of full control of the surgical wound.

Rehabilitation

After the surgical intervention, the patient is shown further rehabilitation. Its volume and duration directly depend on the severity of the initial condition of the patient, the presence of complications. To restore general health, reproductive functions, the use of antimicrobial, analgesic and anti-inflammatory drugs, vitamins, immunomodulators is indicated. In addition, oral contraceptives must be prescribed. In the case of removal of carcinoma, the patient is shown radiation or chemotherapy to stop the spread of cancer cells.

For a period of a month to six months, sexual rest is required, the absence of intense physical exertion. It is forbidden to visit baths, saunas, public pools until the surgical wound is completely healed. If necessary, the doctor may prescribe exercise therapy or physiotherapy. Planning for pregnancy after apoplexy should be postponed for 3-6 months.

Sequelae of a ruptured ovarian cyst

Very often the described pathology does not lead to any unpleasant consequences for the general condition of the body. Possible complications may be caused by concomitant diseases. The negative consequences of cyst rupture include:

  1. Adhesions in the pelvis. Occur during conservative therapy. The adhesive process is due to the presence of blood clots in the abdominal cavity, the long duration of the operation (especially laparoscopic).
  2. Infertility. It is a consequence of the presence of adhesions, hormonal imbalance, chronic inflammatory process, disruption of the normal menstrual cycle.
    1. Regular visits to the gynecologist (at least once every six months).
    2. Timely therapy of inflammatory diseases of the genitourinary system.
    3. Planning for pregnancy.
    4. When diagnosing a cystic formation, treatment should be started immediately.
    5. When taking hormonal contraceptives, regularly undergo an additional examination to detect cysts.

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    Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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This is a small spherical pathological formation with liquid contents, located on the ovary or inside it. As a rule, the formation and development of cysts is asymptomatic: most often they are discovered by chance, during a preventive gynecological examination. Nevertheless, such a finding is a serious cause for concern, since one of the most serious complications of this pathology can be a rupture.

Causes

Many women tend to believe that with the appearance, development and subsequent rupture of an ovarian cyst, only those representatives of the weaker half of humanity who are promiscuous and neglect the rules of intimate hygiene can face. Meanwhile, such a statement is false: no one is immune from the occurrence of this pathology.

Meanwhile, not all types of cysts can be affected by the phenomenon. There are so-called functional cystic formations that form and disappear asymptomatically, imperceptibly to the woman herself. However, in cases where cysts are actively progressing and growing rapidly, there is a high risk of overflow with their contents and rupture.

The phenomenon can be provoked:

  • thinning of the walls of the follicle due to the transferred inflammation of the ovary;
  • hormonal imbalance in the body;
  • pathology of blood clotting;
  • excessive physical activity (for example, lifting heavy objects);
  • active sexual intercourse.

When the membrane is ruptured, the entire contents of the cyst enters the abdominal cavity. This process is fraught with increased danger due to the high risk of developing peritonitis. Inflammatory damage to the abdominal cavity carries a real threat to both the health and life of the patient. That is why, at the first clinical manifestations, you should consult a doctor to confirm the diagnosis and receive qualified medical care, or, on the contrary, to exclude the presence of such a problem.

Signs and symptoms of a ruptured ovarian cyst and its diagnosis

Typical symptoms are:

  • a significant increase in body temperature, the inability to lower it with the help of antipyretic drugs;
  • the appearance of a piercing, acute, incessant pain, localized in the lower abdomen;
  • general malaise, marked weakness;
  • the appearance of vaginal discharge of an unusual consistency;
  • the appearance of uterine bleeding;
  • manifestation of signs of intoxication, including nausea and vomiting;
  • conspicuous pallor of the skin;
  • loss of consciousness;
  • violations of the stool, the process of defecation and the release of gases;
  • sharp decline.

Diagnosis is carried out through:

  • ultrasound examination;
  • taking a puncture (puncture with a special needle) of the peritoneum through the vagina;
  • diagnostic laparoscopy (examination of the state of the abdominal cavity using a special camera placed into it through an opening in the abdomen).

Treatment

Any suspicion of this ailment is a direct indication for the emergency and urgent sending of the injured woman to the hospital. The patient should be taken to the hospital even if the symptoms of blood loss are not expressed: bleeding may be delayed.

IN medical institution, after making an accurate diagnosis and determining the degree of blood loss, the doctor develops an individual program for the treatment and rehabilitation of the patient. Treatment of a disease that occurs in a mild form is carried out conservatively, with the use of medications. If there are complications, surgery (laparoscopic surgery) may be required. During the operation, the damaged follicle and part of the ovary (or the entire ovary) are removed, bleeding is eliminated.

In cases where the phenomenon leads to hypovolemic shock, massive infusion of solutions is used and an emergency laparotomy operation is performed to restore hemostasis.

Consequences

Rupture of an ovarian cyst can lead to a number of negative consequences. In particular:

  • the affected woman is diagnosed with pronounced anemia (), caused by a large blood loss;
  • untimely appeal for the provision of qualified medical care can lead to the death of the patient;
  • adhesions in the pelvis, often occurring after surgery, can cause infertility or contribute to the occurrence of an ectopic pregnancy;
  • inflammation of the peritoneum (purulent peritonitis): in such a situation, repeated surgical intervention is required.

Prevention

It's no secret that any disease, including the above, is easier to prevent than to subsequently cure. That is why all women at risk for this pathology are recommended:

  • regularly, at least once every six months, visit a gynecologist for preventive examinations;
  • promptly identify and treat any inflammatory diseases of the genitourinary system;
  • if a cyst is found, strictly follow the recommendations given by the doctor, do not violate the imposed prohibitions, limit physical activity and reduce the frequency of sexual intercourse;
  • in cases where a specialist recommends removing a cyst in advance, heed his advice: modern surgical techniques are simple, efficient and effective;
  • plan pregnancy.

In case of the slightest suspicion of a rupture, seek medical attention immediately.

Types of cysts that are more often complicated by rupture:

  • Follicular. Belongs to the category of functional. It is formed if the follicle does not rupture during ovulation, and it continues to grow, accumulating exudate inside. Similar neoplasms occur with hormonal disorders. A follicular ovarian cyst can disappear in 2-3 cycles even without any treatment. It does not reach large sizes, on average about 3-4 cm, has a thin capsule, and therefore is often complicated by rupture.
  • corpus luteum. Refers to functional, is formed from the corpus luteum at the site of a burst follicle. It often occurs during pregnancy and resolves on its own until the 16th week. Usually not large and does not bring any particular complaints.
  • endometrioid. One of the frequent cysts that can acquire malignant growth. Initially, small foci of endometriosis are formed, gradually they begin to fill with a thick creamy dark secret, which leads to an increase in the size of the cyst. They are subject to surgical removal, but even in this case they are prone to recurrence. Rupture of an endometrioid ovarian cyst is more often than others subsequently complicated by an adhesive process in the small pelvis, which brings not only pain to a woman, but can also cause infertility.

Endometrial ovarian cyst

Causes of ovarian rupture:

  • physical activity and weight lifting;
  • sexual intercourse, especially intense;
  • injuries in the abdomen;
  • the attachment of inflammation, as a result of which the capsule becomes prone to rupture.

During the rupture of the cyst, the woman feels an instant sharp pain., which then subsides somewhat, but after a while begins to increase if intra-abdominal bleeding continues. Also, a woman may note the following complaints:

  • increasing weakness;
  • dizziness;
  • increased heart rate.

As the condition worsens there may be bloating, there is no discharge of gases and stools. In this case, the pain can be tolerable or very strong. They can be localized in the lower abdomen, give into the anus, perineum.

Vaginal discharge is usually normal. If the rupture of the cyst occurs against the background of inflammation and genital infections, then whites can be worn pathological character: be plentiful, purulent, with an unpleasant odor, etc., body temperature may rise.

Pain and all symptoms are associated with bleeding from a ruptured ovarian cyst. It is from its intensity that the severity of the signs, the nature and degree of pain sensations depend.

Rupture of an ovarian cyst during pregnancy accompanied by a more blurred clinical picture. It is important to undergo a complete examination during planning to exclude such neoplasms.


Ultrasound of the pelvic organs: pregnancy on early term large left ovarian cyst

If medical assistance is not provided in time, the condition can become critical and even pose a threat to the life of a woman. The consequences may be as follows:

  • DIC syndrome. Due to the large blood loss, the processes of blood clotting are disrupted, resulting in massive bleeding, which is sometimes impossible to stop.
  • Thrombosis. If it is possible to avoid DIC, then the likelihood of blood clots increases, the lungs, brain, and heart are the most dangerous.
  • Anemia. It always occurs, resulting in a decrease in the level of hemoglobin and red blood cells.
  • Adhesive character. There is a high probability of formation of connective tissue strands between organs and intestinal loops in the distant postoperative period, pronounced changes can lead to obstruction of the fallopian tubes and infertility.

Pulmonary embolism

Rupture of an ovarian cyst requires surgery. During it, only a cyst, a formation together with an ovary, or appendages on one side can be removed. This also affects the reproductive function of the girl, the reserve of eggs decreases, and problems with pregnancy may arise in the future.

Diagnosis of cyst rupture includes following methods:

  • ultrasonography;
  • puncture of the abdominal cavity through the posterior fornix of the vagina;
  • diagnostic laparoscopy, can immediately turn into a full-fledged operation.

Puncture of the abdominal cavity through the posterior fornix of the vagina

An ectopic pregnancy with a ruptured tube and intra-abdominal bleeding is accompanied by similar symptoms. Therefore, to exclude this condition, it is recommended to do a urine test or take a blood test for hCG during the examination.

If the ultrasound confirms the presence of fluid in the abdominal cavity, it is necessary to establish its nature. For example, it can be blood or pathological effusion (as a result of inflammation, an oncological process). For this, it is carried out culdocentesis- puncture of the abdominal cavity through the posterior fornix of the vagina. Manipulation is carried out as follows:

  1. An obstetrician-gynecologist, after treating the vagina with a special needle, pierces the vaginal wall in the region of the posterior fornix.
  2. If there is blood in the abdominal cavity, it begins to flow out, and blood loss can be judged by the pressure of the jet.

If the clinical situation is not clear even after culdocentesis, diagnostic laparoscopy can be performed. If necessary, immediately goes into operation.

It is extremely rare for a cyst to rupture without surgery. If the formation was small, the blood loss is minimal, the clinical picture fades on its own. However, in such situations, one should always be extremely careful, since a slight bleeding may continue from a torn capsule with a relatively normal state of health of the girl. In any case, this cyst will not go away on its own, it is removed in a planned manner.

- the most optimal and modern variant of surgical intervention. The benefits are as follows:

  • low tissue trauma;
  • additional blood loss is minimal;
  • soreness in the area of ​​​​sutures is minimal, often no narcotic painkillers are required;
  • rehabilitation in the postoperative period is short, lasts a week or two compared to a month after the usual intervention.

It is carried out as follows:

  1. The woman is placed on the operating table, the anesthesiologist performs general anesthesia.
  2. First, carbon dioxide is injected into the abdominal cavity to visualize the organs. After that, the manipulators and the camera are introduced, the whole operation is performed.
  3. Once everything is done, the manipulators are removed and the sutures on the skin are sutured. Over time, they heal and become almost invisible.

After 2 hours, you can get up, and the next day, many people forget that there was an operation.

  • appendages on one side.

Stages of removal of the endometrioid ovarian cyst

If laparoscopy is not possible, standard surgery is performed. In this case, a longitudinal or transverse incision of the skin and all layers of the anterior abdominal wall is made, all manipulations are performed directly by the surgeon's hands and standard instruments. This treatment option is less preferred for the following reasons:

  • cosmetic defect, especially if the incision is longitudinal, from the navel down;
  • there is additional blood loss, as tissues are damaged;
  • rehabilitation for about a month;

Read more in our article on ovarian cyst rupture and treatments.

Read in this article

Types of cysts

Ovarian cysts can be functional if they pass on their own and do not bring serious disorders. They can also be permanent. In the latter case, it is necessary to remove them for histological examination and to establish the true nature. A cyst rupture can occur with any neoplasm and at the most inopportune moment, pose a danger to a woman's life.

corpus luteum

It also refers to functional, it is formed from the corpus luteum at the site of a burst follicle. It often occurs during pregnancy and goes away on its own until the 16th week. The cyst of the corpus luteum of the ovary is usually not large and does not bring any special complaints.

Follicular

Belongs to the category of functional. It is formed if the follicle does not rupture during ovulation, and it continues to grow, accumulating exudate inside. Usually, such neoplasms occur with hormonal disorders, especially in girls with the onset of menarche and in women during the formation of menopause.

The ovarian follicular cyst usually disappears in 2-3 cycles even without any treatment, if it is not complicated. As a rule, it does not reach large sizes, on average, about 3-4 cm, it has a thin capsule, which is why it is often complicated by rupture.

endometrioid

One of the frequent cysts that can acquire malignant growth. The endometrioid ovarian cyst is acquired. At the beginning, small foci of endometriosis are formed, gradually they begin to fill with a thick creamy dark secret, which leads to an increase in the size of the cyst.

They are subject to surgical removal, but even in this case they are prone to recurrence, since the systemic disease remains.

Rupture of an endometrioid ovarian cyst is more often than others subsequently complicated by an adhesive process in the small pelvis, which brings not only pain to a woman, but can also cause infertility.

There are other types of cysts, but they are less likely to be complicated by rupture.

Any event that is accompanied by an increase in intra-abdominal pressure can provoke a rupture. If the cyst is tense, then even a slight tension is enough, for example, during coughing, when straining in case of constipation, etc.

Symptoms of pathology: pain, discharge

During the rupture of the cyst, the woman feels an instant sharp pain, which then subsides somewhat, but after a while begins to increase if the intra-abdominal bleeding continues. Also, a woman may note the following complaints:

  • increasing weakness;
  • dizziness;
  • increased heart rate.

As the condition worsens, bloating may occur, there is no discharge of gases and stools. In this case, the pain can be tolerable or very strong. They can be localized in the lower abdomen, give into the anus, perineum.

Vaginal discharge is usually normal. If the rupture of the cyst occurs against the background of inflammation and genital infections, then the leucorrhea can be pathological in nature: it can be abundant, purulent, with an unpleasant odor, etc., the body temperature may rise.

Pain and all symptoms are associated with bleeding from a ruptured ovarian cyst. It is from its intensity that the severity of the signs, the nature and intensity of pain sensations depend.

Rupture of an ovarian cyst during pregnancy is accompanied by a more blurred clinical picture, which in general can adversely affect the course of gestation and the condition of the fetus. Therefore, it is important to undergo a complete examination during planning to exclude such neoplasms.

Watch this video about the symptoms of a ruptured ovarian cyst:

Consequences for a woman

The main danger of rupture of an ovarian cyst is massive bleeding. If medical assistance is not provided in time, the condition can become critical and even pose a threat to the life of a woman.

Sequelae of a ruptured ovarian cyst
DIC Due to the large blood loss, blood coagulation processes are disrupted, as a result, even more massive bleeding occurs, which is sometimes impossible to stop.
Thrombosis If it is possible to avoid DIC, then the likelihood of blood clots in any place increases, the lungs, brain, and heart are the most dangerous.
Anemia It always occurs, since the rupture of an ovarian cyst is almost always accompanied by a large blood loss, resulting in a decrease in the level of hemoglobin and red blood cells.
Adhesive character There is a high probability of formation of connective tissue strands between organs and intestinal loops in the late postoperative period, pronounced changes can lead to obstruction of the fallopian tubes and infertility.

In addition, ovarian cyst rupture requires surgical intervention. During it, only a cyst, a formation together with an ovary, or appendages on one side can be removed. It also affects the reproductive function of the girl, the egg reserve decreases and problems with pregnancy may arise in the future.

Ultrasound and other diagnostic methods

Rupture of an ovarian cyst is an acute surgical condition. Its diagnostics includes the following methods:

  • ultrasonography;
  • puncture of the abdominal cavity through the posterior fornix of the vagina;
  • diagnostic laparoscopy, which can immediately turn into a full-fledged operation.

Ultrasound research pursues several goals at once. During it, you can find the following:

  • the presence of free fluid in the abdominal cavity;
  • a formation on the ovary, similar to a cyst, sometimes even a gap is visible;
  • other diseases with a similar clinical picture can be excluded.

Ultrasound is performed using a vaginal sensor, for completeness, an abdominal sensor can also be attached.

Expert opinion

Daria Shirochina (obstetrician-gynecologist)

An ectopic pregnancy with a ruptured tube and intra-abdominal bleeding is accompanied by similar symptoms. Therefore, to exclude this condition, it is recommended to do a urine test or take a blood test for hCG during the examination.

If the ultrasound confirms the presence of fluid in the abdominal cavity, it is necessary to establish its nature. For example, it can be blood or pathological effusion (as a result of inflammation, an oncological process). For this, culdocentesis is performed. The procedure is a puncture of the abdominal cavity through the posterior fornix of the vagina. Manipulation is carried out as follows:

  • The girl is placed on a gynecological chair.
  • Local anesthesia or intravenous anesthesia is carried out.
    • Rupture of an ovarian cyst on ultrasound

    Detection of blood is a direct indication for surgical intervention.

    If the clinical situation is not clear even after culdocentesis, diagnostic laparoscopy can be performed. During it, the ovaries are visualized, it can be seen whether there is blood in the abdominal cavity and in what quantity. If necessary, they immediately proceed from diagnosis to treatment: to the removal of a cyst and, if necessary, a part or a whole complex of appendages.

    Watch in this video about the picture of pelvic ultrasound with a rupture of an ovarian cyst:

    Is treatment possible without surgery?

    As a rule, the rupture of an ovarian cyst is always accompanied by a decent intra-abdominal bleeding, which requires urgent surgical treatment. The clinical picture can develop within a few days.

    It is extremely rare for a cyst to rupture without surgery: if the formation was small, blood loss is minimal, and the clinical picture fades on its own. However, in such situations, you should always be extremely careful, from a torn capsule, slight bleeding may continue with a relatively normal state of health of the girl. In any case, such a cyst will not go away on its own and will have to be removed in a planned manner.

    Laparoscopic removal of the cyst capsule and ovary

    This is the most optimal and modern version of surgical intervention in such situations. The advantages of laparoscopy for ruptured ovarian cysts are as follows:

    • low tissue trauma;
    • only 3 small incisions are made: in the navel, in the right and left iliac regions;
    • additional blood loss is minimal, since there is no need to make large incisions;

      • However, laparoscopy requires a certain qualification of the doctor and special equipment. It is carried out as follows:

      • The woman is placed on the operating table, the anesthesiologist performs general anesthesia - intubation anesthesia.
      • First, carbon dioxide is injected into the abdominal cavity to visualize the organs. After that, manipulators and a camera are introduced, through which the whole operation is performed.
      • Once everything is done, the manipulators are removed and the sutures on the skin are sutured. Over time, they heal and are almost invisible.

      After 2 hours, you can get up, and the next day, many people forget that there was an operation.

      The amount of intervention may vary depending on the clinical situation. The following operation options are possible:

      • only the cyst is husked, and the bed on the ovary is sutured;
      • part of the ovary is removed along with the cyst;
      • appendages on one side.

      The scheme of the operation to remove the ovarian cyst

      The abdominal cavity is always washed from blood, if necessary, drainage is installed.

      Other options for the operation

      If it is not possible to perform laparoscopic intervention in case of rupture of the ovarian cyst capsule, a standard operation is performed. In this case, a longitudinal or transverse incision of the skin and all layers of the anterior abdominal wall is made, all manipulations are performed directly by the surgeon's hands and standard instruments. This treatment option is less preferred for the following reasons:

      • cosmetic defect, especially if the incision is longitudinal, goes down from the navel;
      • there is additional blood loss, as tissues are damaged;
      • in the postoperative period, serious anesthesia is necessary;
      • rehabilitation lasts about a month;
      • the likelihood of developing adhesions and other complications is higher.

      After any type of intervention, all removed material is sent for histological examination, according to which the final diagnosis is established.

      Rupture of an ovarian cyst is a serious condition that almost always requires surgical intervention, since the pathology is accompanied by bleeding into the abdominal cavity. It is preferable to perform laparoscopy, but if such an operation is not possible in an emergency, a standard laparotomy is performed.

An ovarian cyst is a benign formation, which is an outgrowth of glandular tissue in the form of a bubble or sac that is filled with serous fluid. In the case of an inflammatory process, pus is formed inside the sac, which can lead to inflammation of the peritoneum and purulent-infectious blood pathologies in case of rupture of the cyst. In most cases, women are diagnosed with follicular cysts - growths of the glandular epithelium that occur at the site of rupture of the follicular walls during the period of ovulation.

Experts believe that women of reproductive age are most susceptible to cystic formations. After 45 years, pathology is less common, but the frequency of its occurrence is high enough to pay enough attention to diagnosis and visit a doctor in a timely manner, since in the event of a rupture, the consequences can be very serious (up to the death of a woman).

Cystic formations in most cases do not require medical and surgical correction and resolve on their own. This mainly applies to follicular cysts, which disappear 1-2 months after ovulation. One of the varieties of follicular growths - a corpus luteum cyst - is also not dangerous and resolves within 2-3 months if conception does not occur.

Even if the cyst does not manifest itself in any way and does not increase in size, the woman should still be under the supervision of specialists, since under the influence of adverse factors, the pathology can progress rapidly. These factors include:

  • violation of the synthesis of sex hormones, manifested by the irregularity of the menstrual cycle;
  • obesity (especially 3 and 4 degrees);
  • any form of diabetes (including gestational diabetes);
  • diseases of the pelvic organs occurring against the background of acute inflammatory processes;
  • abortion or the need for curettage for therapeutic or diagnostic purposes (for example, to stop uterine bleeding).

Important! Even functional cysts can degenerate into malignant tumors. This process cannot be controlled, so the only sure way to avoid the development of cancer is the timely treatment and removal of pathological growths.

Reasons for the gap

About half of all cases of ovarian cyst rupture are associated with inflammatory processes inside the formation. The inflamed walls of the sac become very thin and can burst from any, even minor, physical exertion. Lifting weights, playing sports, running at a fast pace - all this can provoke a rupture of the inflamed formation, therefore, with diagnosed cysts, you must be very careful with your body and avoid any stress, especially if they are associated with lifting heavy objects.

Caution should also be exercised by lovers of active sexual intercourse, since any careless movement or too deep penetration of a partner can cause damage to the cystic walls and increase external pressure on the formation, which will lead to rupture of the cyst.

All kinds of injuries (especially falls) can also cause the inflamed cyst to burst, but this happens mainly against the background of a sluggish inflammatory process.

Note! Women with blood diseases, as well as poor clotting, are advised to remove any cystic formations on the ovaries without waiting for spontaneous resorption, since the risk of rupture is 40-60% higher than in women who do not suffer from these diseases.

Symptoms and danger signs

Symptoms of cyst rupture are always pronounced and appear immediately after the violation of the integrity of the sac. The first and most important symptom is acute pain in the abdomen from the localization of the pathological process. Most often, pain occurs during intercourse, trauma, enemas. To reduce the severity of pain, a woman tends to sit down, unconsciously takes a characteristic pose, trying to pull her bent in knee joints legs closer to the stomach (a symptom of a vanka-vstanka). During vaginal examination (only for specialized ambulance teams), a sharply painful enlarged ovary, flattening of the arches, overhanging of the posterior fornix, its sharp pain (“Douglas cry”) can be felt during palpation, and with a digital examination of the rectum, overhanging, soreness of it front wall.

After the rupture of the cyst, the purulent contents enter the tissues of the peritoneum, which affects the nature and further localization of painful sensations. With blood loss of more than 150 ml, the clinical picture is mainly due to hemoperitoneum, and its severity depends on the duration and intensity of bleeding.

  • common signs of blood loss - decreased pressure, rapid pulse, weakness, dizziness, pallor of the skin, nausea, sometimes loose stools - occur with a BCC deficiency, usually more than 15%;
  • bloating, pain in the abdomen without a clear localization with irradiation to the anus, the inner surface of the thigh;
  • symptoms of peritoneal irritation (Blumberg-Shchetkin);
  • phrenicus symptom (pain on palpation between the legs of the sternocleidomastoid muscle on the right);
  • symptom of Kulenkampff (soreness and symptoms of irritation of the peritoneum without tension of the abdominal wall);
  • dullness of percussion sound in the sloping parts of the abdomen.

All symptoms indicate the need for urgent medical care.

Note! Pain syndrome at the localization of the cyst appears about a few hours (less often - a day) before its rupture. The pain is usually nagging, the intensity increases as inflammation develops and the walls of the cystic sac become thinner. If you go to the hospital for this stage, severe complications (the most dangerous of which are sepsis and peritonitis) can be avoided.

Pathological discharge

Immediately after the rupture of the cyst, a woman has uncharacteristic discharge, most often bloody or containing streaks of blood. It is worth paying attention not only to the consistency of the discharge (they should not have blood clots), but also to the smell. The discharge, indicating that a cyst has ruptured, does not have a sharp or unpleasant odor, does not cause itching, burning, and other unpleasant symptoms.

Important! If inflammatory process was accompanied by the formation of pus, the discharge may contain impurities of purulent contents of a yellowish-brown color. It can be small lumps or thick veins with a slight odor.

Signs of intoxication

The process of cyst rupture is always accompanied by an increase in temperature, which can reach up to 40 ° (in rare, especially severe cases - higher). A distinctive feature of fever in this pathology is that the temperature is stable and does not go astray with traditional drugs based on paracetamol or ibuprofen.

At the same time, the woman develops chills, severe weakness on the part of the muscular system, and a general deterioration in well-being. There may be uncontrolled vomiting, severe nausea. At very high temperatures, convulsions, tremors of the limbs often occur, and sticky sweat may appear. From the very moment of the rupture, a woman is tormented by intense thirst due to the drying of the mucous membranes of the oral cavity.

Lowering blood pressure

Blood pressure during rupture of an ovarian cyst drops even in women suffering from a chronic type of arterial hypertension. Clinically, this is accompanied by other symptoms, including:

  • strong heartbeat;
  • decrease in heart rate;
  • pathological pallor of the skin (possible development of cyanosis - cyanosis of the skin and mucous membranes, caused by an increase in the concentration of reduced hemoglobin in the blood);
  • dizziness;
  • disorientation in space.

Important! In especially severe cases (when the pressure drops below 80/60 mm Hg), loss of consciousness and the occurrence of hallucinations are possible. In no case should you try to correct the situation yourself, as the help of the resuscitation team may be required. The first thing to do when any warning sign appears is to call the emergency medical team.

Symptoms from the digestive system

One of characteristic features the ingress of serous or purulent fluid into the peritoneal cavity is a sensation of swelling. The abdomen becomes tight and painful, outwardly looks like an inflated ball. This symptomatology is difficult to diagnose in overweight women, but the doctor will be able to determine the tension of the abdominal muscles during palpation.

Other digestive disorders are mild (sometimes completely absent), but in some cases a woman may experience:

  • pain in the abdominal region and epigastrium;
  • fermentation of gases in the intestines;
  • acute diarrhea.

These symptoms cannot be treated in isolation. Only in combination with other signs of pathology do they give a general idea of ​​the clinical picture of the existing disorders.

Video - Ovarian cyst burst. Symptoms

Rupture of an ovarian cyst: first aid and treatment

The treatment of the rupture is only surgical. After the diagnostic measures taken, the doctor, using a special device, will remove the pathological formation and surrounding tissues. If necessary, complete or partial excision of the genital or reproductive organs is possible. During the operation, drainage of the abdominal cavity is performed in order to remove pus and flush the peritoneum.

To remove the cyst in a hospital, two methods can be used: laparoscopy and laparotomy.

Type of interventionDescriptionComplication rate
LaparoscopyThe cyst and pathologically altered tissues are removed using a laparoscope - an endoscopic device in the form of a thin tube, at the end of which an optical device is fixed. Removal is carried out through small holes with a diameter of not more than 1.5 cmNegative effects are associated mainly with the infusion of the drug for anesthesia. In some cases, incomplete removal of the formation is possible, which leads to a repeated inflammatory process.
LaparotomyThe operation is performed using a surgical scalpel. The cyst is removed through a classic incision that is made in the abdomen. Stitches required after surgeryThe frequency of complications and negative consequences does not exceed 30-35%. Most often, they are not associated with the characteristics of the operation, but with the patient's health status and existing chronic diseases.

First aid for a ruptured cyst is to call an ambulance, since it is impossible to help the patient at home in this situation. Before the arrival of medical workers, the woman should be in a horizontal position.

Important! It is strictly forbidden to take painkillers before the doctor examines the woman. This is a necessary measure to exclude other dangerous pathologies with similar symptoms, for example, inflammation of the appendix. Taking analgesics will blur the clinical picture of the ailment and may cause a false diagnosis.

An ovarian cyst in itself is not considered a dangerous pathology, but its rupture can lead to serious consequences and the death of a woman from acute peritonitis or purulent blood poisoning. To prevent this from happening, you need to monitor your health and undergo a preventive examination by a gynecologist on time (every year). If the next ultrasound study showed a cystic growth on the ovary, it is best to consult a doctor about the possibility of removal. If there are no urgent indications for this, it is necessary to observe preventive measures to prevent rupture of the formation and be observed by a gynecologist - this will help to identify pathological changes in time and carry out the necessary therapy.

The most severe complication of neoplasms of the genital area is the rupture of an ovarian cyst - this is a pathological condition in which the entire contents of the cystic formation fills the peritoneal region.

The process is dangerous with the possibility of developing peritonitis, which threatens the life of the patient. This fact, in turn, requires an immediate appeal to a specialist at the slightest suspicion of a ruptured cystic formation.

ICD-10 code

D27 Benign neoplasm of ovary

Causes of a ruptured ovarian cyst

Unfortunately, not a single woman is immune from the appearance of cystic formation. Formation and self-resorption functional view tumors are often asymptomatic. But not all cysts are prone to regression.

The processes of active growth of a neoplasm with an increase in liquid content are dangerous due to the possibility of overstretching and loss of capsule integrity.

There are the following causes of ovarian cyst rupture:

  • inflammatory diseases of the ovaries, resulting in thinning of the follicular wall;
  • hormonal imbalance;
  • blood clotting disorders;
  • excessive physical activity (weight lifting, etc.);
  • frequency and activity in sex.

Symptoms of a ruptured ovarian cyst

Symptoms of an "acute abdomen" indicate torsion of the tumor stem or rupture of the formation. A sharp pain in the abdomen, an increase in body temperature up to 39°C, vomiting, muscle tension in the peritoneum can serve as a reason for emergency surgical intervention.

Typical symptoms of a ruptured ovarian cyst, indicating a violation of the integrity of the formation:

  • temperature that is not brought down by antipyretics;
  • piercing, growing pain syndrome, like a dagger strike, mainly in the lower abdomen;
  • feeling of weakness, general unstable state;
  • vaginal discharge of an unusual nature;
  • uterine bleeding;
  • severe intoxication with nausea or vomiting;
  • blanching of the skin;
  • pre-fainting / fainting state;
  • stool changes, problems with defecation and gas removal;
  • pressure drop.

As a rule, the rupture of an ovarian cyst does not entail dysfunction of the vital organs of the peritoneum. In patients, in view of the severe pain syndrome, there is a moderate tachycardia of a permanent nature, which is not a cause for concern. A blood test may reveal a decrease in hemoglobin levels.

Warning symptoms of a ruptured ovarian cyst that indicate internal bleeding include:

  • increasing tachycardia;
  • jumps in blood pressure;
  • orthostatic disorders.

Pain from a ruptured ovarian cyst

The collection of anamnesis in case of rupture of an ovarian cyst indicates that the nature and intensity of the pain syndrome differ significantly and depend on:

  • type of cystic formation;
  • the day of the menstrual cycle in which the gap occurred;
  • physical activity of the patient.

For example, a ruptured ovarian cyst of the dermoid type is accompanied by excruciating, sharp pain. The onset of ovulation (the middle of the monthly cycle) occurs with moderate soreness associated with the release of the egg from the burst follicle, which is a follicular type of cyst.

Rupture of any type of tumor is described by sudden painful sensations, localized mainly on one side of the lower abdomen. Quite often, pain during rupture of an ovarian cyst covers upper divisions abdomen, so women complain of soreness of the entire abdominal area.

Provoke pain and rupture of the tumor wall are capable of physical exercise, sexual intercourse, injuries (during a blow, fall, as a result of surgery, etc.). Often the pain increases during movement, which is a sign of peritoneal irritation. The pain syndrome is often followed by loss of consciousness, which facilitates the diagnosis.

Before the rupture, lumbar pain or discomfort of the pelvic zone of a pulling nature, a feeling of heaviness can be observed.

Rupture of a corpus luteum cyst

Rupture of a corpus luteum cyst is a rather rare phenomenon, since the cystic formation has a thick capsule. The loss of the integrity of the membrane is accompanied by acute, piercing pain in the lower abdomen, forcing the patient to "fold in half." Moreover, the temperature can remain normal, with obvious signs intoxication, severe weakness, the presence of cold sweat, fainting.

If the rupture of the corpus luteum cyst occurred in the vascular zone of the ovary, hemorrhage into the peritoneum and pelvic organs is possible. Such a sudden filling of the ovary with blood with blood entering the peritoneum and small pelvis is called ovarian apoplexy. The woman's condition will range from mild weakness, drowsiness to stupor and shock, depending on the amount of blood lost.

Apoplexy against the background of the rapid growth of cystic formation can be triggered by a rapid change in body position (jumps, somersaults, etc.), a blow, sudden movements, active sexual intercourse.

The presence of intra-abdominal bleeding is determined by factors: pallor of the skin and mucous membranes, an increase in heart rate and a decrease in pressure.

The choice of treatment method (conservative / operative) in this case is influenced by: the abundance and degree of bleeding, the ability of blood to coagulate, the general well-being of a woman.

Rupture of a follicular ovarian cyst

The follicular type of cyst is a neoplasm capable of self-disappearance when the hormonal background is stabilized by taking hormonal contraceptives.

Dagger pain syndrome indicates a rupture of the follicular ovarian cyst, which occurs with severe symptoms of intoxication and normal body temperature.

The risk of violating the integrity of the capsule of an actively growing cystic formation is especially high when physical activity, sexual intercourse, during gestation.

Symptoms of a ruptured cystic neoplasm include:

  • weakness, fainting, dizziness;
  • lowering blood pressure;
  • urge to vomit;
  • clinic of "acute abdomen" - dagger-like pain in the lower abdomen, leading to the development of shock;
  • cyanosis (blue) or pallor of the skin.

Rupture of a follicular ovarian cyst can occur against the background of intra-abdominal hemorrhage, which is characterized by a lethargic, weak state, frequent heartbeat at low pressure, and shock.

Violation of the integrity of the cystic capsule is a critical condition for the patient, often leading to purulent peritonitis, severe loss blood, anemia, the development of the adhesive process and the inability to know the joy of motherhood.

Rupture of a functional ovarian cyst

Recall that every healthy woman monthly forms a natural cyst in one of the ovaries, which is called the dominant follicle or Graf's follicle. At ovulation, the follicle bursts, releasing an egg ready to be fertilized in the fallopian tube. The dominant follicle develops into the corpus luteum, which serves to maintain hormonal balance when carrying a child.

In some cases, for reasons unknown to medicine, the Count's follicle does not burst, but continues to increase in volume due to the accumulation of fluid in it. This is how a follicular (retention) cyst appears, less often a cyst of the corpus luteum, which are classified as functional (physiological type) tumors.

The rupture of a functional ovarian cyst occurs suddenly with acute pain in the lower abdomen, accompanied by weakness, dizziness, pallor of the skin, sometimes with bloody discharge from the vagina, not associated with menstruation.

The greatest danger is bleeding into the peritoneal area, so at the first sign of a ruptured cyst, emergency medical care should be called.

Rupture of the endometrioid cyst

Endometrioid cysts are surgically removed due to the high probability of rupture of the cystic capsule, the possibility of transformation into a malignant formation.

A tumor of this type is predominantly located in the vicinity of large vessels that feed the ovary. Endometrioid formation on the ovary is not a single one, often foci of endometriosis are detected on the surface of the peritoneum, Bladder and other organs.

Spontaneous rupture of the endometrioid cyst with the outflow of contents into the peritoneum is dangerous for the development of intestinal paresis, an adhesive process.

Tumor perforation is characterized by severe, paroxysmal pain in the lower abdomen, accompanied by nausea and vomiting. Possible loss of consciousness. There is also a weakening of intestinal motility, bloating. The patient's body temperature may be normal.

Rupture of a cyst during pregnancy

According to statistics, cystic neoplasms that develop along with pregnancy are quite common. The greatest concern is caused by large cysts up to 8 cm in diameter, requiring surgical intervention. Most often, tumors are removed by laparoscopy at the fourteenth to sixteenth week of gestation, if the formation continues to grow rapidly, which is confirmed by an ultrasound scan. Cases with particularly large cysts may require laparotomy.

Such pathological conditions as: torsion and rupture of the cyst during pregnancy entail bleeding, acute pain, can provoke premature labor or miscarriage. For this reason, doctors recommend surgery for the growth of cystic formation.

Pregnant women with two types of cysts are at risk:

  1. cystadenoma (filled with fluid or mucus), up to 12 cm in diameter and characterized by a constant excruciating pain syndrome;
  2. endometrioid or "chocolate" - consists of a brown, bloody substance that resembles chocolate. As a consequence of endometriosis, such a tumor is formed with a hormonal imbalance. When it ruptures, the abdominal cavity fills with blood.

The described types of tumors are subject to mandatory removal, regardless of the duration of pregnancy.

Sequelae of a ruptured ovarian cyst

The loss of the integrity of the wall of the cystic formation always entails a number of factors unfavorable to the health of the patient:

  • anemia (anemia develops due to extensive blood loss);
  • death due to untimely access to medical personnel;
  • adhesive process, as a result of surgery, leading to infertility and increasing the risk of pregnancy outside the uterine cavity;
  • the phenomenon of purulent peritonitis, which often requires washing the abdominal cavity and repeated surgery.

In especially severe cases, the consequences of a ruptured ovarian cyst lead to the complete removal of the affected ovary, which becomes a problem for conception.

Treatment of a ruptured ovarian cyst

In order to diagnose the rupture of the cystic formation of the ovary, the following research methods are used:

  • puncture method - puncture of the peritoneal wall through the vagina through a special needle;
  • laparoscopy - the study of the state of the ovary thanks to a special camera (the image is displayed on the monitor), inserted through an incision into the peritoneal area.

If there is the slightest suspicion of rupture of the cyst, even in the absence of bleeding (which is often delayed), the woman should be immediately taken to the hospital. The hospital establishes an accurate diagnosis, classifies the degree of blood loss, on the basis of which an individual treatment and rehabilitation program is selected.

Treatment of mild ovarian cyst rupture is carried out by conservative methods, with the help of pharmacological preparations. In the presence of complications, surgery (laparoscopy) may be necessary, during which the follicle is excised, as well as the ovary, partially or completely.

In order to remove the patient from the state of hypovolemic shock, infusion of solutions is used, and emergency laparotomy is used to restore homeostasis.

In parallel, anti-inflammatory therapy, physiotherapy (to prevent adhesions) are prescribed, hormonal preparations are individually selected. With heavy blood loss include hemostatic therapy, blood transfusion.

Surgery for ruptured ovarian cyst

Abundant blood loss during rupture of an ovarian cyst is a reason for surgical intervention. The most common method is considered to be laparoscopy. During surgery, the bleeding can be stopped. The damaged follicle and part of the ovary are cut out. Sometimes the entire ovary has to be removed. If bleeding does not pose a threat, then improvement is achieved by bed rest and cold compresses on the stomach.

Laparoscopy is an operation for a ruptured ovarian cyst, in which three holes are made in the wall of the peritoneum (near the navel) for the introduction of a camera with illumination and surgical instruments. In this case, use general anesthesia. abdominal cavity filled with a special gas to "inflate" the stomach and move the intestines for unimpeded penetration to the ovary.

The procedure is considered less traumatic and most effective. However, as a result of obstructed visibility, injuries to nearby organs, damage to the vessels of the puncture zone, and postoperative bleeding are possible.

Prevention of ruptured ovarian cyst

Any pathological condition is easier to prevent than to treat. Therefore, women with neoplasms should follow a number of rules.


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