Cysts Aggravated: Complications of Ovarian Cysts
While ovarian cysts are common occurrences in women’s bodies and would come and go without any pomp and fanfare, there are rare cases when these would lead to risks that would require immediate attention.
Following are the two common complications of ovarian cysts: Complication 1: Torsion twisted ovary caused by torsion
Ovarian cysts that become large that is, about 4-5cms in diameter may cause the ovary to move out of its usual position in the pelvis.
This may lead to partial or complete rotation or twisting of the ovary often together with its fallopian tube. Ovarian torsion restricts blood supply to the ovary triggering ovarian necrosis or death of the ovarian tissues. Death of ovarian tissues may have an impact on your fertility such as sub-fertility.
If left untreated, ovarian torsion can have serious medical ramifications. The soreness induced by the twisting of the ovaries can result in infection and septic shock. There have been many cases of this ovarian complication resulting in injuries of the urinary system and also clots within the blood veins of the ovary. Blood clots in the lungs or pulmonary emboli tend to accompany the blood clots located in the ovarian tissues.
Between the left and right ovaries, it is the right side that commonly suffers from ovarian torsion because the sigmoid colon restricts the mobility of the left ovary.
Although ovarian torsion can occur in any age group, it is much more common in women of who are in their childbearing years where about 70-75% occurs in females under 30 years old. Despite most recorded torsion cases happening in pre-menopausal women of childbearing age, up to 17% of cases also affect pre-pubertal and postmenopausal females.
Pregnancy also poses a significant risk for torsion; this is because pregnancy results in the enlargement of the ovary in combination with laxity of the supporting tissues of the ovary. 20-25% of all cases of ovarian torsions occur during pregnancy with the greatest risk occurring in the first trimester and immediately postpartum.
For pre-pubertal patients, the risk of ovarian torsion is increased with the presence of congenital development abnormalities like malformed and elongated fallopian tubes. Similarly, women who have undergone previous pelvic surgery, particularly tubal ligation, tend to have adhesions to surrounding tissue opening the ovary to potentially twist around it which then results in torsion. Signs and Diagnosis
Patients would usually complain of sudden onset of severe unilateral lower abdominal pain normally occurring during agitating movements. The pain may be felt up to the back, thigh, and pelvic area. Nausea and vomiting may likewise be present.
An abdomen and pelvic examination will be conducted by the physician where tenderness of the affected ovary may be revealed. CT scanning and ultrasonography can assist with diagnosis. The absence of blood flow within an ovary can support the diagnosis of torsion. Complication 2: Rupture
Ruptured ovarian cysts occur when one or more of the fluid-filled sacs burst open. When this happens, excruciating pain can be felt. Life-threatening complications can stem from ovarian cyst rupture as leakage of cystic fluid into the stomach cavity can lead to sepsis or hemorrhagic problems. Like ovarian torsion, this can also affect fertility which may lead to possible infertility.
This type of complication commonly occurs with corpus luteum cysts and involves the right ovary in 66% of the cases. This is suspected to be because the left ovary is in part cushioned by the large bowel thus protecting it from trauma and twisting. Whereas the part of the bowel behind the right hand side of the ovary offers less support thus making the right ovary vulnerable to twisting. Signs and Diagnosis
Aside from the severe pain that can be felt before or just after the monthly period, additional generic symptoms include nausea which can occur because the ruptured cyst may leak fluid or blood into the peritoneal cavity. Likewise, this leakage and subsequent irritation of the peritoneal cavity can also cause vomiting. Weakness, dizziness, or fainting can also accompany a ruptured cyst.
Despite the symptoms being similar to an ovarian cyst that has not ruptured, attention should still be given to these signs as these could be serious symptoms of internal bleeding.
Physicians who are handling patients with potential cyst rupture should be able to immediately rule out ectopic pregnancy, provide adequate pain control, and promptly assess the patient for hemodynamic instability. Most cases only require observation while some may need laparoscopy where an incision needs to be made for further diagnosis.
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