Ruptured ovarian chocolate cyst
Introduction
Introduction to rupture of ovarian chocolate cyst Pelvic endometriosis is very easy to affect the ovary. The ectopic endometrium periodically bleeds in the ovarian tissue to make the ovary grow and form a chocolate cyst. This cyst is often bilateral, and the ovarian chocolate cyst is due to various factors. The rupture can occur repeatedly under the influence of spontaneous or external force. The rupture can occur repeatedly. After the rupture, the old blood overflows into the abdominal cavity, causing severe abdominal pain, nausea and vomiting, etc., and often requires emergency treatment. Cyst rupture occurs mostly in the premenstrual and menstrual periods. The rupture of ovarian chocolate cysts has become a new type of acute abdomen in the field of gynecology. In the past, it has been poorly understood and often overlooked. Now its understanding has gradually deepened, so it has attracted attention. basic knowledge The proportion of illness: the prevalence rate is about 0.005% Susceptible people: women Mode of infection: non-infectious complication:
Cause
Ovarian chocolate cyst rupture cause
(1) Causes of the disease
Ovarian endometriotic cysts can rupture under the following conditions:
1. Repeated bleeding before or during menstruation to increase intracapsular pressure.
2. When progesterone levels are increased during pregnancy or when exogenous progesterone is used, progesterone causes vascular proliferation, congestion and edema, and tissue softening and rupture.
3. The presence of an ovulation mouth can also cause a cyst to rupture.
4. Due to external force squeeze, sexual life pressure or gynecological examination can also cause cyst rupture.
(two) pathogenesis
Ovarian chocolate cysts are often bilateral. The early surface of the cyst is smooth, the wall of the cyst is thin, and the fibrous thickening occurs with repeated bleeding in the menstrual cycle. It is rough, and it adheres to the broad ligament, the uterus and the attachment, and the wall becomes thick and thin. Both are brittle, when the capsule wall blood vessels are congested, tissue softening or menstrual bleeding, increased intracapsular pressure or affected by external force (such as increased abdominal pressure), it is easy to cause cyst rupture.
When the ovarian chocolate cyst ruptures, the amount of sac fluid outflows varies, and the severity of abdominal pain varies. For example, the rupture hole is small, and the content is not much, causing local inflammatory reaction and fibrous tissue hyperplasia, and is quickly surrounded by surrounding tissues. The old blood that overflows into the pelvic cavity contains a living inner membrane, which can be implanted in the abdominal cavity, which further develops the disease. The ovarian endometriosis cyst is large and the content is more and more, and severe abdominal pain occurs, forming an acute abdomen. disease.
Prevention
Ovarian chocolate cyst rupture prevention
Do a good job of prevention, early diagnosis, and timely treatment.
Complication
Ovarian chocolate cyst rupture complications Complication
If the ovarian chocolate cyst is involved in the vascular wall, it may be combined with internal bleeding.
Symptom
Ovarian chocolate cyst rupture symptoms Common symptoms Repeated bleeding severe pain abdominal pain nausea blood pressure drop shock vaginal bleeding mobile dullness
Symptom
(1) The incidence is mostly before menstruation or the second half of the menstrual cycle (the luteal phase). Because of the sharp increase of intracapsular pressure in the cystic cavity before and after the menstrual period, it is easy to spontaneously rupture or undergo gravity or gynecological examination, and the cyst is ruptured.
(2) No amenorrhea or irregular vaginal bleeding.
(3) sudden onset of severe abdominal pain, starting on one side, followed by pelvic pain, accompanied by nausea and vomiting.
(4) Occasionally, blood pressure drops and shock symptoms may occur.
2. Signs
(1) There are obvious symptoms of peritoneal irritation in the abdomen, with obvious tenderness, rebound tenderness and muscle tension.
(2) Occasional mobility dullness.
(3) Gynecological examination can touch the unclear mass on one side or both sides of the pelvis. The mass is often connected to the posterior wall of the uterus, and it is intimate with the uterus, inactive and tender.
Examine
Examination of rupture of ovarian chocolate cysts
1. Determination of CA125 (ovarian cancer-associated antigen) value CA125 is a high molecular glycoprotein present in the renal ductal epithelial derivative and its biological tissue in the embryonic body cavity epithelial, which can be specifically associated with the monoclonal antibody OC-125. Sexual association, as a tumor-associated antigen, has a certain diagnostic value for epithelial ovarian cancer, but in patients with endometriosis, CA125 can be increased, and with the increase of endometriosis, positive The rate is also rising, and its sensitivity and specificity are very high, so it is helpful for the diagnosis of endometriosis, and can also detect the efficacy of endometriosis.
2. Anti-endometrial antibody (EMAb) Anti-endometrial antibody is an autoantibody that uses the endometrium as a target antigen and causes a series of immunopathological reactions. It is a marker antibody for endometriosis, Mather (Mather) 1982) The study found that patients with endometriosis have anti-endometrial antibodies in the blood, cervical mucus, vaginal secretions and endometrium. The detection rate of anti-endometrial antibodies in patients with endometriosis is 70. From % to 80%, the detection of serum EMAb is an effective method for the diagnosis and efficacy observation of patients with endometriosis.
3. B-mode ultrasound examination shows that the attachment area is closely connected with the uterus and has an irregular cystic cavity. The liquid dark area is filled with diffuse and disorderly fine echo, or uneven flaky echo, or the rectal uterus is concave and liquid. Area.
4. After the vagina puncture, the brown or chocolate turbid liquid is extracted, and even the bloody liquid.
5. MRI examination MRI performance varies, depending on the pulse sequence used and the composition of the lesion, the complete hemorrhagic lesion on the T1, T2 weighted image is a high signal of uniform density, T2 weighted image on the signal.
6. Laparoscopy is the best way to diagnose endometriosis by laparoscopic direct peeping, seeing ectopic lesions or biopsy of visible lesions to determine the diagnosis, and can determine the pelvic cavity according to the microscopic examination Clinical staging of endometriosis and determination of treatment plan, laparoscopic observation should be observed in the uterus, fallopian tube, ovary, uterine fibular ligament, pelvic peritoneal and other parts of the endometriotic lesions, microscopic ectopic focus Features: red, cyan, black, brown, gray, punctate, vesicular, nodular or polypoid lesions.
Diagnosis
Diagnostic diagnosis of ovarian chocolate cyst rupture
diagnosis
Any acute abdominal pain in the menstrual period, the vaginal posterior iliac puncture if the brown or chocolate color liquid can be diagnosed, combined with the patient's past history and signs and imaging examination no more difficult.
Differential diagnosis
1. ectopic pregnancy rupture or abortion The disease has acute abdominal pain, intra-abdominal hemorrhage signs and pelvic mass, similar to ovarian endometriotic cyst rupture, but no previous endometriosis and history of dysmenorrhea, history of menopause, according to Blood, urine HCG examination and posterior iliac puncture can be identified.
2. Ovarian tumor pedicle reversed the history of no dysmenorrhea, no signs of internal bleeding after acute abdominal pain, abdominal wall tenderness and rebound tenderness is not obvious, no moving dullness, gynecological examination of the mass of the perimeter clear, mass tenderness, uterine rectal fossa no nodules , B-ultrasound can be identified.
3. Acute appendicitis Right ovarian endometriotic cyst rupture is easy to be confused with acute appendicitis. The most obvious tender point of acute appendicitis is at the abdominal wall of the appendix, and the uterus rectum is concave and no nodules. The patient has fever and the white blood cell rises. High, posterior iliac puncture can also aid diagnosis, such as pus, it is acute appendicitis.
4. Ovarian corpus luteum rupture This disease occurs mostly before menstruation, no history of dysmenorrhea, abdominal tenderness, rebound tenderness is not obvious, uterine rectal lacuna without nodules, posterior Qianlong puncture fluid is dark red non-coagulation, not brown liquid.
The following identification table 1 is available for clinical reference.
