Definition

Ovarian cyst torsion and rupture are conditions where an ovarian cyst twists and bursts. An ovarian cyst is a fluid-filled sac on or within an ovary.

The ovaries are female reproductive organs located in the pelvis. There are two ovaries, one on each side of the uterus, held in place by ligaments. Each ovary contains thousands of eggs, and due to hormonal stimulation, one egg matures each menstrual cycle.

After ovulation, one mature egg is released from a sac within the ovary (left or right, sometimes both). This sac usually disappears. If the sac retains an egg or fills with fluid, it can form a cyst.

Rupture of Ovarian Cyst

Normal cysts, known as functional cysts, develop in adolescent and young adult women. These cysts usually shrink after ovulation. However, some cysts may grow larger and rupture.

Ovarian Cyst Torsion

Large cysts are at risk of twisting (torsion). Torsion can block blood flow to the ovary, causing permanent damage.

Twisted or ruptured ovarian cysts are medical emergencies requiring immediate treatment to prevent loss of the ovary and potential life-threatening complications.

Causes

Ovarian Cyst Torsion

Torsion occurs due to the increasing size of the cyst, causing the supportive ligaments to twist. This condition leads to ligament swelling and blood flow obstruction. Prolonged obstruction causes ovarian tissue death.

Rupture of Ovarian Cyst

Similar to torsion, rupture occurs due to cyst enlargement, causing the cyst sac to stretch, press, and eventually burst. Excessive physical activity or sexual intercourse can also trigger cyst rupture.

Risk Factor

Ovarian Cyst Torsion

Risk factors for ovarian cyst torsion include:

• Ovarian cysts larger than 5 cm, increasing the likelihood of the ovary twisting against its ligaments
• Young adults are more at risk
• Women with longer-than-normal ovarian ligaments

Rupture of Ovarian Cyst

Risk factors for cyst rupture include:

• Heavy physical activity
• Abdominal trauma
• Abdominal pressure
• Anticoagulant medications

Symptoms

Symptoms of ovarian cyst torsion and rupture usually appear suddenly. Some cases may be asymptomatic or show mild symptoms. Common symptoms include:

• Sudden, sharp lower abdominal pain
• Abdominal cramps
• Nausea and vomiting
• Hard abdomen
• Heavy vaginal bleeding
• Fever
• Pelvic pressure or heaviness
• Pain during intercourse
• Changes in bowel movements
• Irregular menstrual cycles

For more information on ovarian diseases like Ovarian Cancer, read here: Ovarian Cancer - Understanding, Cause, Symptoms, And Treatment.

Diagnosis

Diagnosis of ovarian cyst torsion and rupture involves collecting data from symptom history, physical examination, and additional tests. The doctor will conduct a medical interview to gather information on the patient's complaints and other symptoms to rule out other diagnoses that cause similar symptoms to ovarian cyst torsion and rupture.

Physical Examination

The doctor will examine the lower abdomen for enlargement and perform palpation to detect any masses or tenderness.

Laboratory Examinations

Additional tests include a complete blood count, urine analysis, and pregnancy tests to rule out conditions like urinary tract infection, appendicitis, and ectopic pregnancy. Blood tests often reveal anemia due to bleeding from a torsion or rupture.

Abdominal Ultrasound

Radiological tests like abdominal ultrasound can locate the twisted or ruptured ovarian cyst and assess its size and shape. Transvaginal ultrasound can also check for obstructed blood flow or blood accumulation in the pelvic and abdominal cavities due to cyst rupture.

Management

Ovarian cyst torsion and rupture are emergencies requiring prompt treatment to prevent life-threatening complications and ovarian loss. Treatment steps include:

• Monitoring vital signs: blood pressure, heart rate, temperature, and respiratory rate
• Fluid therapy to replace blood/fluid loss from cyst rupture
• Pain relief medications and anti-nausea/vomiting drugs
• Monitoring hemoglobin levels to assess blood loss
• Repeated and periodic ultrasound examinations are required to determine the severity of obstructed blood flow and the amount of blood flowing into the pelvic/abdominal cavity
• Laparotomy (abdominal surgery) must be performed immediately to stop the bleeding caused by ovarian cyst rupture. Furthermore, this action allows for detorsion, which is the release of a twisted ligament

Complications

Complications of ovarian cyst torsion include ovarian tissue death. If it lasts for a long time, it can cause damage to the entire ovarian tissue, necessitating the removal of the ovarian organ. Infertility may result from the removal of both ovaries. In addition, complications from the surgical procedures include bleeding, infection, scar tissue formation, blood clots, and tissue damage to blood vessels or nerves.

If an ovarian cyst ruptures, it can lead to life-threatening complications. When an ovarian cyst ruptures, the body loses a large amount of blood, which leads to a lack of fluids and shock. Other complications of ovarian cyst rupture range from pelvic and abdominal infections to sepsis.

Prevention

Preventing ovarian cyst torsion and rupture involves avoiding heavy physical activity, as it increases the risk of large cysts twisting or bursting. Oral contraceptives can prevent ovulation, reducing new cyst formation.

If an ovarian cyst is detected, the doctor may recommend surgical removal before it grows large and risks twisting or bursting.

When to See a Doctor?

Seek immediate emergency care if you experience sudden, severe lower abdominal pain and heavy vaginal bleeding to receive prompt treatment and care.

Looking for more information about other diseases? Click here!