Ovarian apoplexy

Ovarian apoplexy is an acute hemorrhage into the ovarian tissue accompanied by rupture of the ovary and bleeding into the abdominal cavity. It is an acute gynecological emergency. Ovarian apoplexy most commonly occurs in women aged 20–36 years. It accounts for approximately 1–3% of all gynecological conditions, occurring in approximately 1 in 25,000–30,000 women. The recurrence rate may reach 50–65%. Ovarian apoplexy usually occurs during the second half of the menstrual cycle, when the permeability of ovarian blood vessels increases and the blood supply to the ovary becomes greater.

Causes

Factors predisposing to ovarian apoplexy include pelvic inflammatory diseases (adnexitis), prolonged use of blood-thinning medications, and hormonal imbalances.

Symptoms

The condition usually begins with sudden, severe pain in the lower abdomen. Pain most commonly occurs after physical exertion or during sexual intercourse, although it may also develop at rest. The pain is generally localized on the side of the affected ovary.

As bleeding into the abdominal cavity progresses, the clinical presentation changes: the intensity of the pain may decrease somewhat, while the pain may spread throughout the abdomen. Increasing weakness, nausea, and dizziness may develop. The heart rate increases, and blood pressure may decrease.

Diagnosis

Diagnosis of ovarian apoplexy requires a comprehensive evaluation. In addition to reviewing the patient’s symptoms and medical history and performing a gynecological examination, an ultrasound examination is required. Ultrasound may reveal free fluid in the abdominal cavity and changes in the structure of the ovary. A complete blood count may show decreased hemoglobin levels and a reduced red blood cell count.

Treatment

In most cases, treatment is surgical. If bleeding from a ruptured ovary is present, emergency surgery is indicated. This may involve laparoscopy or laparotomy, suturing of the ovary (or removal of the ovary in cases of extensive rupture), and control of the bleeding.

Only in rare cases — when hemorrhage is confined to the ovarian tissue without bleeding into the abdominal cavity — may conservative treatment be used.

Patients with suspected ovarian apoplexy should be urgently transported to a multidisciplinary hospital providing 24-hour emergency care.