Ruptured ovarian cyst is a common occurrence amongst women of the reproductive age group, and can be either symptomatic or asymptomatic. Ovarian cysts are sacs filed with fluid which develop on the ovaries.
Patients suffering from ruptured ovarian cysts may present with the following symptomatology:
The following laboratory diagnostics and tests are performed to patients with high suspicion for ruptured ovarian cyst:
The majority of cases of ruptured ovarian cysts are treated conservatively due to their self-limiting clinical courses. Oral pain relievers to alleviate abdominal pain may be given and patients are advised bed rest. Although patients with high risk of evolving abdominal pain may benefit from anticipatory management of serial ultrasound and frequent abdominal examination to ascertain the need for surgery .
Surgical laparotomy may be opted when there are substantial signs of peritoneal hemorrhage where the cyst is either removed, cauterized, sutured or ligated to stop the bleeding . In the extreme event, that bleeding is not surgically suppressed, options of salpingoophorectomy may be considered during the laparotomy.
The general prognosis for ruptured ovarian cysts is good. A tolerable abdominal pain and a self-limiting bleeding may be the only symptom. Symptoms may spontaneously resolve in days to weeks depending on the amount of blood spillage or fluid accumulation in the peritoneal cavity. This medical condition may rarely cause death in cases of circulatory collapse, hemorrhagic shock, and disseminated intravascular coagulation (DIC).
The following clinical conditions are common in a ruptured ovarian cyst:
The exact etiology associated with the ruptured ovarian cyst is still unclear up to date. There are many theories according to which this problem may be caused by abdominal trauma or a long term anti-coagulation therapy . Ruptured ovarian cyst only occurs in the reproductive age groups of 18-35 year old.
There are no available data as to the exact epidemiology of ruptured ovarian cyst. Although physiologic ruptures of follicular and luteal ovarian cysts are fairly common among women in their reproductive age, they are usually self-limiting and not usually worked up and sufficiently documented.
The pathophysiology of a ruptured ovarian cyst begins with the monthly rupture of a mature follicle to release the ovum in preparation for fertilization. In rare instances, the follicles may bleed and cause a cortical stretch and pain. Bleeding may sometimes emanate from the ruptured site of the follicle causing a direct hemorrhage to the peritoneal space. In the same way the corpus luteum may also bleed prior to ovulation or before a pregnancy.
The unabated intraperitoneal hemorrhage may cause signs and symptoms of hemodynamic instability among patients due to hemorrhagic shock. Non-physiologic cysts like dermoid cysts, endometrioma and cystadenomas may also rupture and cause bleeding. Although the exact cause of the spontaneous rupture is unknown, abdominal trauma and anticoagulation therapy is closely implicated in these phenomenon.
In the case of ruptured dermoid cysts or mature cystic teratomas, sebaceous fluids may also spill in the peritoneal cavity causing chemical peritonitis.
Women in reproductive age with history of ovarian cysts must avoid from contact sports and other recreational activities that may lead to abdominal trauma and cause ovarian cyst rupture. Patients on long term anti-coagulation therapy must take necessary steps to monitor any abdominal discomforts to prevent internal hemorrhage.
Ruptured ovarian cyst is a common clinical condition characterized usually by mild abdominal pain among women . In rare occasions, the associated abdominal pain may be severe enough to require some form of analgesia. Ruptured ovarian cyst may cause hemorrhages and may spontaneously resolve; however, there are rare cases which cause massive internal bleeding and death .