Surgical treatment of ovarian apoplexy (rupture)

Ovarian apoplexy is an acute condition in which hemorrhage occurs in the ovarian tissue, sometimes with its rupture and internal bleeding. It is usually accompanied by sudden severe pain in the lower abdomen, weakness, and dizziness. In cases of significant blood loss, urgent surgical intervention is necessary to stop the bleeding and, if possible, preserve the ovary.

At the Oxford Medical medical center in Kyiv, surgical treatment of ovarian rupture is performed by experienced gynecological surgeons. Operations are performed in a hospital equipped with modern equipment, mainly using the laparoscopic method, which allows minimizing injury to healthy tissues.

Doctors at Oxford Medical recommend immediately calling an ambulance if sudden severe pain occurs in the lower abdomen, especially with weakness or dizziness. These may be signs of internal bleeding, which, without timely treatment, can lead to significant blood loss and pose a threat to life.

Depending on the predominance of symptoms, three forms of ovarian apoplexy are distinguished:

• painful — characterized by sudden acute pain in the lower abdomen, while pronounced signs of internal blood loss are absent;

• hemorrhagic (anemic) — signs of internal bleeding predominate (weakness, dizziness, pale skin, rapid heartbeat, and decreased blood pressure);

• mixed — combines pronounced pain in the lower abdomen with signs of internal blood loss.

Such a division is conditional, since internal bleeding is possible even in the absence of pronounced symptoms of blood loss. The severity of the condition depends primarily on the volume of blood lost and circulatory disturbances. To assess the patient's condition and select treatment tactics, ultrasound and laboratory tests are performed.

Most often, apoplexy occurs during or after ovulation, when the corpus luteum forms in the ovary. During this period, the tissues have an intensive blood supply, so damage to small blood vessels may cause hemorrhage and sometimes even rupture of the ovary, with blood entering the abdominal cavity.

Main causes and risk factors:

• hemorrhage into the corpus luteum with the formation of a hemorrhagic cyst;

• blood clotting disorders that increase the risk of bleeding;

• taking anticoagulants — medications that reduce blood clotting;

• intense physical exertion, lifting heavy objects, or sexual intercourse, which sometimes provoke rupture;

• abdominal injuries that may lead to damage to ovarian tissues.

According to a study published in PubMed, bleeding from the corpus luteum may occur spontaneously, while blood clotting disorders and the use of anticoagulants increase the risk of significant internal blood loss.

At the same time, apoplexy may occur without injuries or physical exertion, even during ordinary daily activities. Therefore, the absence of an obvious cause does not rule out ovarian rupture.

The severity of symptoms does not always correspond to the severity of the condition. Even if the pain gradually subsides, internal bleeding may continue. Therefore, if ovarian apoplexy is suspected, an urgent consultation with a gynecologist and an examination are necessary.

Doctors at Oxford Medical emphasize that similar symptoms may occur with ectopic pregnancy, ovarian torsion, and acute appendicitis. Therefore, in the event of sudden severe abdominal pain, it is necessary to seek medical attention immediately. Weakness, dizziness, and fainting are particularly dangerous, as they may indicate significant internal blood loss.

The main danger of apoplexy is internal bleeding. When the blood vessels of the ovary are damaged, blood may accumulate in the abdominal cavity. If the bleeding continues, the volume of blood lost increases, which leads to a decrease in blood pressure and impaired blood supply to vital organs.

In the absence of timely medical care, the following are possible:

• significant blood loss — a decrease in hemoglobin levels and the development of acute anemia;

• hemorrhagic shock — a life-threatening condition caused by a sharp decrease in the volume of circulating blood;

• damage to ovarian tissues — in cases of severe damage, it is not always possible to preserve the organ;

• formation of adhesions — after hemorrhage into the abdominal cavity, adhesions may form between the pelvic organs.

The severity of the condition depends primarily on the intensity of bleeding and the volume of blood loss. In cases of minor hemorrhage, conservative treatment under medical supervision is sometimes possible. If the bleeding continues or the woman's condition worsens, urgent surgery is necessary.

If ovarian apoplexy is suspected, it is necessary to conduct an examination as soon as possible to confirm the diagnosis, assess possible blood loss, and determine whether urgent surgery is needed.

Main diagnostic methods:

• Ultrasound of the pelvic organs — allows assessment of the condition of the ovaries, detection of signs of hemorrhage, and the presence of free fluid in the abdominal cavity;

• complete blood count — helps assess hemoglobin and hematocrit levels, which may decrease with blood loss;

• blood test for hCG — necessary to rule out ectopic pregnancy, which may be accompanied by similar symptoms;

• coagulogram — allows detection of blood clotting disorders that may increase bleeding.

According to the American College of Radiology (ACR), ultrasound with Doppler imaging is the main method of initial imaging for acute pelvic pain in women of reproductive age. If necessary, the doctor may prescribe additional examinations. If the diagnosis remains uncertain and the patient's condition requires surgical intervention, diagnostic laparoscopy is performed. It allows direct examination of the pelvic organs and, if necessary, immediate control of bleeding.

In most cases, the operation is performed using the laparoscopic method — through 3–4 small punctures in the abdomen. Through them, the surgeon inserts a video camera and special instruments, with which the bleeding is stopped. This method allows minimizing injury to healthy tissues, reducing postoperative pain, and shortening the recovery period.

In cases of significant blood loss or an unstable condition of the patient, laparotomy may be required — an open operation through an incision in the abdominal wall. It provides direct access to the ovary and allows the necessary manipulations to be performed quickly.

Both types of intervention are performed under general anesthesia.

The main stages of the operation:

• Examination of the pelvic organs. The surgeon identifies the source of bleeding, assesses the condition of the ovary and the volume of blood in the abdominal cavity.

• Stopping the bleeding. The surgeon stops the bleeding using coagulation or suturing. If necessary, the surgeon performs removal of an ovarian cyst or damaged tissues, preserving the healthy part of the organ. If the organ is severely damaged and cannot be preserved, complete removal of the ovary — oophorectomy — is performed.

• Completion of the operation. The doctor removes blood and clots, checks whether the bleeding has stopped, and then closes the punctures or surgical incision with sutures.

At the Oxford Medical surgical hospital, gynecological operations are performed using minimally invasive techniques. After the intervention, the patient remains under the supervision of medical personnel. In cases of significant blood loss, transfusion of blood components may be required.

The duration of recovery depends on the method of surgery, the volume of blood loss, and the patient's general condition. After laparoscopy, it is usually possible to gradually return to everyday activities within 1–2 weeks. After open surgery, rehabilitation may last 4–6 weeks or longer.

In the first few days, moderate pain in the lower abdomen, weakness, and discomfort in the area of the sutures are possible. If there was significant blood loss, recovery of strength may take longer.

Main recommendations after surgery:

• start walking as early as the first day, if the state of health allows;

• avoid lifting heavy objects and intense physical activity for 2–4 weeks or longer as recommended by the surgeon;

• keep postoperative wounds clean and follow the rules for suture care;

• gradually return to the usual diet, consume enough fluids and protein-rich foods;

• refrain from sexual intercourse until the tissues have healed and the gynecologist has given permission;

• take prescribed medications and undergo a follow-up examination.

Treatment after ovarian apoplexy may include iron supplements for anemia and other medications according to the examination results. If the ovary has been preserved, its function usually gradually recovers.

Doctors at Oxford Medical recommend seeking medical attention immediately if, after surgery, the temperature rises to 38 °C or higher, abdominal pain increases, heavy bleeding, severe weakness, or dizziness occurs. Such symptoms may indicate an infection, recurrent bleeding, or other complications that require urgent examination and treatment.

The consequences of apoplexy depend on the volume of blood loss, the degree of ovarian damage, and the timeliness of treatment. Possible consequences include:

• adhesions — the formation of adhesions between the pelvic organs after hemorrhage or surgical intervention;

• chronic pelvic pain — periodic painful sensations that may be associated with adhesions and other changes in the tissues;

• impaired reproductive function — difficulties with conception due to damage to ovarian tissues or adhesions;

• recurrent apoplexy — the possibility of a new hemorrhage in the same or the other ovary.

Even after the removal of one ovary, natural pregnancy remains possible if the other functions normally. At the same time, women who have experienced apoplexy are recommended to undergo regular follow-up examinations with a gynecologist, especially in the presence of pain, menstrual cycle disorders, or difficulties with conception.

The cost of the operation depends on the method and extent of surgical intervention, as well as the duration of the hospital stay. You can review the prices for medical services in advance here. The doctor will be able to specify the cost of treatment more precisely after the examination and determination of the extent of the necessary intervention.

If you want to book a consultation with a gynecologist or clarify information about surgical treatment, call the contact center at the number indicated on the website.

If ovarian rupture is suspected, emergency medical care is necessary. At Oxford Medical, you can call an ambulance. The clinic's surgical hospital operates around the clock and has modern operating rooms and an intensive care unit for monitoring and treating patients in serious condition.

The information is for informational purposes and does not replace a doctor's consultation.

Sources:

• US National Library of Medicine

• American College of Radiology

• National Institutes of Health