An ovarian cyst is a benign pathological formation, which is a bubble with semi-liquid or liquid contents, which can increase the volume of the ovary several times. Volumetric ovarian formation is most often detected during a physical examination, however, an ultrasound scan is necessary to confirm the diagnosis .
In most patients, ovarian cysts occur without symptoms and do not impair function and ability to conceive. However, during pregnancy, an ovarian cyst torsion can occur, provoked by sudden changes in the position of the pregnant woman’s body, weight lifting, sexual intercourse, hard work, increased abdominal pressure from prolonged coughing, etc. In such cases, torsion of the legs of the ovarian cyst leads to compression of the arterial and venous trunks that are in the ovaries.
With a slow torsion, within 90-120 degrees, the nutrition of the ovaries is usually not disturbed, everything can be asymptomatic. When the legs are twisted 180 degrees or more, thin-walled veins can be squeezed, which makes the blood flow in them slow down or even stop altogether. As a result, venous stasis develops , the tumor grows in size and hemorrhage occurs in its cavity. In severe cases, rupture of the cyst occurs, accompanied by severe bleeding in the abdominal cavity. A complete cessation of blood flow leads to necrotic changes in the cyst, which threatens the development of severe peritonitis.
Acute torsion of the ovarian cyst accompanied by severe pain in the lower abdomen, increased heart rate, nausea, vomiting, fever up to 38C. Pain syndrome can sometimes be accompanied by shock phenomena: cold extremities, a frequent pulse, pallor of the skin, decreased blood pressure, the appearance of a sticky cold sweat , etc.
The reasons why the ovarian cyst torsion occurred are not always clear. The following factors can play a known role in this complication: sharp rotations by the body, increased blood pressure in the tumor or veins of the tumor legs, long legs, transition of the cyst into the abdominal cavity, increased intestinal motility, and overflow of the bladder.
In order for torsion of the ovarian cyst to occur, she (the cyst) should have not only a long, but also a sufficiently mobile leg.
If the tumor in the appendages detected during the vaginal examination has a tight-elastic consistency, painful on palpation, as well as when trying to displace it, then such patients need surgical treatment, and urgent. In such cases, the tumor is removed without unwinding to avoid thromboembolism, because thrombi may be present in her leg. After its removal, it is desirable to conduct a histological diagnosis, after which a final choice of the volume of surgical intervention is possible.
With small cysts (up to 1 cm), wait-and-see tactics are used if the ultrasound does not show tight inclusions - obvious signs of a tumor.
Conservative therapy involves the use of hormonal drugs aimed at preventing (or reducing) the growth of tumors.
Surgery by laparoscopy is used after waiting for two to three menstrual cycles. If the cyst has not disappeared, it is removed, preserving healthy ovarian tissue as much as possible.
Ovarian Cyst: Diagnosis
Diagnosis of the disease with acute torsion of the legs usually does not cause difficulties. The initial diagnosis is based on the patient's history and characteristic complaints. On examination, all the signs of an “acute abdomen” are most often determined: signs of irritation of the peritoneum and muscle tension of its anterior wall. Vaginal examination allows palpation of a painful lesion associated with the ovary. Internal bleeding is not observed.
With partial torsion, all symptoms are less pronounced, however, with the slightest suspicion of cyst torsion, patients need examination, in-patient observation and surgical treatment.