Complications of a Ruptured Ovarian Cyst
Although often a ruptured ovarian cyst is in itself a painful and serious condition, there are potentially serious complications which must be considered. These include twisting of the ovary, due to the size and location of the cyst, which may lead to infertility. Leakage of cystic fluid into the abdominal cavity may cause sepsis, or there may be hemorrhagic complications. In the long term, a patient who has experienced a ruptured ovarian cyst may suffer chronic pelvic pain syndrome.
Ovarian cysts larger than 4cm are likely to cause twisting of the ovary. Twisting, also known as torsion is more likely to occur if the cyst is accompanied by a tumor. The problem with ovarian torsion is that it may restrict the blood supply to the ovary, which causes death of the ovarian tissue, known as ovarian necrosis. Death of ovarian tissue will have ramifications for your future fertility; however the associated inflammation may also lead to infection, septic shock and death. There have also been reported cases of ovarian torsion leading to injury to the urinary tract as well as to clotting in the ovarian blood vessels. Blood clots in the lungs, known as pulmonary emboli, are sometimes secondary to blood clots in the ovarian vessels. A twisted ovary will need to be remedied surgically, most often using an open-abdomen, rather than laparoscopic approach.
Ovarian cysts are often complicated by hemorrhage. It is important to note that abdominal hemorrhage is different to hemorrhage from a ruptured endometriomas. When endometriomas rupture, the blood that leaks into the abdominal cavity is from the cyst itself. The source of blood in abdominal hemorrhages is from an organ in the abdomen. This is potentially more serious, as the volume of leaked blood is greater. The source of the bleed needs to be located and stopped.
Often, the right ovary seems to be involved in hemorrhagic complications than the left. This is thought to be because the left ovary is in part cushioned by the large bowel, preventing damage from trauma and twisting. The part of the bowel behind the right hand side of the ovary provides a lot less support, exposing the right ovary to twisting. It is likely that an ovarian cyst complicated by hemorrhage will require some sort of surgery to either stop the bleeding, or remove the hemorrhaged material.
A further complication of a ruptured ovarian cyst is peritonitis. Typically defined as an inflammation of the mucous membrane which lines the abdominal cavity and organs contained within them, peritonitis is a serious condition. It is often caused by an infection, which in the case of a ruptured ovarian cyst, may be the result of leaked cystic fluid. Typically the peritonitis is localized to the immediate area of ovaries and fallopian tubes.
Rupture of an ovarian cyst can lead to scarring, also known as adhesions. These are particularly problematic if the scarring is on the ovaries, because this may limit the ovaries’ ability to release eggs and therefore restrict fertility.
Although the complications associated with a ruptured ovarian cyst are potentially serious and, in some cases life threatening, these complications occur relatively infrequently. Seeking medical advice if you are experiencing any of the symptoms associated with an ovarian cyst is critical and may reduce the likelihood of complications.