bubble_chart Overview

Ovarian rupture occurs when a mature follicle or corpus luteum ruptures for some reason, leading to bleeding. In severe cases, it can cause significant intra-abdominal hemorrhage. There are two types: follicular rupture and corpus luteum or corpus luteum cyst rupture. This condition can occur in both married and unmarried women, with the highest incidence among women of reproductive age.

bubble_chart Etiology

(1) Spontaneous rupture: This refers to the situation where an ovarian follicle hematoma or corpus luteum hematoma continues to expand, and when the internal pressure increases to a certain extent, rupture occurs. Its occurrence is associated with several predisposing factors: ① It is closely related to ovarian congestion, such as mechanical factors like ovarian compression, torsion, or {|###|}prolapse of uterus{|###|}, long-term {|###|}vagina{|###|} douching, or conditions like {|###|}pelvic inflammation{|###|}, acute or chronic {|###|}appendicitis{|###|} that cause ovarian congestion; ② Changes in ovarian function, such as excessive cold or hot baths, prolonged use of estrogen or progesterone, can lead to functional changes in the ovaries, or excessive activity of the ovarian enzyme system due to the influence of the autonomic nervous system, resulting in a tendency to bleed or coagulation disorders; ③ Changes in blood composition, such as partial platelet damage and alterations in blood components caused by {|###|}pestilence{|###|} diseases, anemia, malnutrition, or other conditions before {|###|}menstruation{|###|}, leading to bleeding.

(2) Direct or indirect external force affecting the ovary leading to rupture, such as intercourse, increased intra-abdominal pressure (straining during bowel movements, {|###|}nausea{|###|}, {|###|}vomiting{|###|}, lifting heavy objects, etc.).

bubble_chart Clinical Manifestations

Generally, there is no history of irregular menstruation or amenorrhea. Most cases occur during the intermediate stage [second stage] of menstruation or before menstruation, with a sudden onset of severe pain in the lower abdomen, which quickly becomes persistent dull pain and may gradually lessen or worsen again. Occasionally, there may be nausea and vomiting, but these symptoms are not prominent. Usually, there is no vaginal bleeding, but severe internal bleeding may lead to shock symptoms.

Physical examination: In mild cases, there is only grade I tenderness in the lower abdomen. If the condition occurs on the right side, the tender point is located below and medial to McBurney's point, at a lower position. In severe cases, there is obvious tenderness in the lower abdomen with rebound tenderness, but the rigidity of the abdominal muscles is less pronounced than in generalized peritonitis.

Bimanual examination: Cervical motion tenderness is present, and tenderness is noted in both fornices. The uterus is of normal size, and movement of the uterine body causes pain. In cases of significant internal bleeding, fullness may be felt in the adnexal area or posterior fornix. Sometimes, an enlarged ovary may be palpated.

bubble_chart Diagnosis

Ovarian rupture is difficult to diagnose due to the lack of typical symptoms and often occurs on the right side, making it highly prone to confusion with acute appendicitis or misdiagnosis as an ectopic pregnancy. The key to accurate diagnosis lies in carefully inquiring about the {|###|}menstruation history, combined with clinical manifestations and examinations, for comprehensive analysis.

The timing of ovarian rupture has a certain relationship with the menstrual cycle, which can serve as a primary basis for diagnosis. Approximately 80% of ovarian ruptures involve the corpus luteum or luteal cysts, thus typically occurring after ovulation, mostly in the last week of the menstrual cycle, and occasionally on the first or second day of menstruation. A minority of cases involve follicular rupture, often occurring in mature follicles, with onset generally between the 10th and 18th days of the menstrual cycle. Patients with ovarian rupture usually have no history of ovarian dysfunction, and most have regular ovulation cycles. Abdominal tenderness is not prominent, but bimanual pelvic examination reveals significant tenderness. Combined with a history of menstrual disease, a diagnosis can often be made. If there is a history of onset after intercourse, the likelihood is even greater.

bubble_chart Treatment Measures

Bed rest, close observation, and taking Chinese medicinals primarily aimed at invigorating blood and resolving stasis, breaking accumulations and masses, with appropriate addition of heat-clearing and detoxicating medicinals.

In cases of severe internal bleeding with shock symptoms and critical condition, immediate surgery should be performed to avoid delaying treatment.

For surgical precautions, anesthesia, and autologous blood transfusion, refer to the chapter on tubal pregnancy.

The principle of surgery must strive to preserve ovarian function. Typically, the rupture site of the ovary or blood flowing from the recently formed corpus luteum can be observed. The rupture can be sutured with fine catgut in a continuous locking stitch, or the corpus luteum cyst can be excised followed by continuous locking suturing of the edges.

bubble_chart Differentiation

(1) Acute appendicitis: Ovarian rupture occurs more frequently on the right side and is highly prone to misdiagnosis as acute appendicitis. Acute appendicitis typically begins with upper abdominal pain or generalized abdominal pain, gradually localizing to McBurney's point, with notable nausea and vomiting. Tenderness, rebound tenderness, and abdominal muscle rigidity are more pronounced. On bimanual examination, cervical motion tenderness and uterine mobility pain are mild, whereas ovarian rupture presents in complete antagonism to these findings. Mild ovarian rupture symptoms gradually alleviate, while acute appendicitis exhibits signs of internal hemorrhage, which are absent in appendicitis.

(2) Ruptured tubal pregnancy or late abortion: Ovarian rupture is easily misdiagnosed as ruptured tubal pregnancy or late abortion. However, careful inquiry into menstrual history and noting the timing of symptom onset within the menstrual cycle can generally aid differentiation. Tubal pregnancy often presents with a brief history of amenorrhea, slight vaginal bleeding, and recurrent abdominal pain. Pelvic tenderness is marked, and a mass may be palpable. Other factors, such as a history of infertility, also differ from ovarian rupture.