APOPLEXY OF THE OVARY (apoplexia ovarii; grech, apoplexia paralysis; synonym: haematoma ovarii, haemorrhagia ovarii, rupture of a yellow body, heart attack of an ovary, rupture of an ovary, hematoma of an ovary) — suddenly come hemorrhage in an ovary which is followed by disturbance of an integrity of its fabric and bleeding in an abdominal cavity.
For the first time bleeding from an ovary was described by F. W. Scanzoni in 1845.
According to M. S. Malinovsky, And. I. occurs at 0,3% of gynecologic patients. In 0,5 — 2,5% of cases intra belly bleeding results And. I.
Pregnancy, periods, sexual excitement always cause a hyperemia of bodies of a small pelvis. Insignificant hemorrhage in an ovary at a rupture of a follicle is observed in the course of an ovulation. As a rule, these hemorrhages are not followed by any clinical symptoms.
At some disturbances in neurovegetative and endocrine systems there is an increase in secretion of luteinizing hormone of a hypophysis that causes strengthening of physiological hemorrhages in an ovary. At the same time can arise And. I. owing to a congestive hyperemia, vessels varicose expanded or sclerosed, and also sclerous changes in a stroma of ovaries. Changes of vessels and tissue of an ovary are result of the previous pathological process, most often the inflammation of appendages of a uterus which is quite often arising because of appendicitis.
precedes Bleeding from an ovary formation of a hematoma in its fabrics, edges causes sharp pains because of increase of intra ovarian pressure. Then there can be a rupture of tissue of ovary. Even at a small opening (and it, as a rule, seldom exceeds 1 cm in the diameter) there are considerable bleedings. Bleeding can arise from the opening which remained after the former ovulation.
At microscopic examination come to light characteristic for And. I. the multiple centers of hemorrhages in tissue of an ovary, it is the most frequent in its bast layer.
And. I. often the injury, physical tension, the rough or interrupted sexual intercourse, intrauterine syringings etc. precedes. However And. I. can arise also in a condition of absolute rest, and even during sleep.
And. I. can come in various phases of a menstrual cycle, but most often in the period of an ovulation or a stage of vascularization and blossoming of a yellow body. The most frequent bleeding point is the yellow body or its cyst. The possibility of a rupture of a yellow body is not excluded during pregnancy.
A.ya. arises, as a rule, at women at the age of 20 — 35 years, is more often in the right ovary.
And. I. always intra belly bleeding and pains accompany. On dominance of one of these symptoms conditionally distinguish an anemic form of a disease and painful. At identical expressiveness of these symptoms speak about the mixed form A. I.
The disease begins sharply with sudden, sometimes very severe pains in the bottom of a stomach with preferential localization on side of the affected ovary. Pains often irradiate in a rectum, a hip, a waist.
At survey of the patient tension of a front abdominal wall, not sharply expressed symptoms of irritation of a peritoneum is noted. At percussion liquid in an abdominal cavity can be defined; at plentiful bleedings arise frenikus-symptom (see) and collapse (falling of arterial pressure, frequent pulse, weakness, cold sweat).
Quite often the attack is followed by nausea and vomiting, and also an unconscious state. Temperature remains normal.
At vaginal examonation in the presence of a small hematoma the increased ovary of spherical shape, a softish consistence, sharply painful is palpated at a palpation. At larger hemorrhage the education similar to an oothecoma is palpated. The uterus is, as a rule, not increased.
In the presence of a considerable hemoperitoneum and irritation of a peritoneum the palpation of a uterus and appendages is complicated.
the Diagnosis is established on the basis of the anamnesis and data of survey of the patient.
The anemic form of a disease is often taken for pipe pregnancy (see. Extrauterine pregnancy ), painful — for appendicitis (see). The final diagnosis is established on the operating table though there are symptoms, on the Crimea sometimes it is possible to carry out differential diagnosis between these states. And. I. comes suddenly among full wellbeing, is more often in the middle of a menstrual cycle. Unlike pipe pregnancy, a delay of periods and signs of pregnancy is not present; outside bleeding, as a rule, is absent; biological responses on pregnancy negative. Unlike appendicitis, at And. I. temperature normal or subfebrile, increase of number of leukocytes is not noted; the irritation of a peritoneum is not so strong, as at appendicitis.
Cases of a combination are frequent And. I. With pipe pregnancy, an acute appendicitis (P.F. Buzykin), and also bilateral And. I. Therefore during operation surely examine both ovaries, uterine tubes and an appendix. Such survey is necessary also at operation for pipe pregnancy since the ovary can appear the main bleeding point.
In certain cases specification of the diagnosis has no crucial importance since tactics of the doctor is defined by intensity of bleeding irrespective of its reason.
Forecast at timely made operation favorable.
At considerable bleeding and in not clear cases operation — a chrevosecheniye, a resection or sewing up of an ovary is shown.
The ovary can be deleted only at the massive hemorrhage entirely striking its fabric. At a rupture of a yellow body of pregnancy it is necessary to take in it, without making a resection, otherwise pregnancy will be interrupted. In the absence of plentiful bleeding in an abdominal cavity it is possible to be limited to conservative actions: rest, cold on a stomach, antiinflammatory therapy.
Bibliography: Vasilyev A. A. To an etiology of an apoplexy of an ovary, Akush. and gi-nek., No. 6, page 57, 1960, bibliogr.; it, Bilateral apoplexy of ovaries, Ka-eansk. medical zhurn., No. 3, page 61, 1962; Verbenko A. A. About an apoplexy of an ovary at a uterine and extrauterine pregnancy, Vopr. okhr. mat. also it is put., t. 6, No. 7, page 70, 1961, bibliogr.; it, Apoplexy of an ovary, M., 1970, bibliogr.; Skantsoni F. V. Diseases of female generative organs, the lane with it., t. 2, SPb., 1874; FigarellaJ., Bonneau H. et Em-r a n J. Les h6morragies intra-p6riton6a-les du corps Jaune, Presse m6d., t. 73, p. 3001, 1965, bibliogr.; Koskela O. Intraperitoneal ovarian hemorrhages not connected with ectopic pregnancy, Ann. Chir. Gynaec. Fenn., v. 55, p. 103, 1966, bibliogr.
H. D. Seleznyova.