What happens when a large ovarian cyst ruptures?

From the Guidelines

When a large ovarian cyst ruptures, it can lead to severe abdominal pain, bleeding, and peritoneal irritation, necessitating immediate medical attention, especially if the cyst is over 5cm in diameter or if there are signs of infection or hemodynamic instability 1.

The rupture of a large ovarian cyst can cause a range of symptoms, including sudden, severe abdominal pain, often on one side of the pelvis, nausea, vomiting, dizziness, weakness, and in some cases, fever if infection develops. The severity of these symptoms depends on the size of the cyst, the amount of bleeding, and whether the contents of the cyst cause inflammation or infection.

Key considerations in managing a ruptured ovarian cyst include:

• The size of the cyst: Cysts over 5cm are at a higher risk of rupture and may cause more severe symptoms 1.
• The type of cyst: Certain types, like endometriomas or dermoid cysts, can cause more severe inflammation when they rupture due to their contents.
• The presence of infection or hemodynamic instability: These complications require immediate medical attention and possibly emergency surgery.
• The need for imaging: Ultrasound or CT scans may be used to assess the situation and guide treatment.

Treatment options vary based on the severity of symptoms and complications:

• Mild cases may be managed with pain medications, rest, and monitoring.
• Severe cases, particularly those with significant bleeding, signs of infection, or hemodynamic instability, require immediate medical attention and possibly emergency surgery, which may involve laparoscopy or laparotomy to control bleeding and remove damaged tissue 1.

From the Research

Rupture of Ovarian Cysts

• A ruptured ovarian cyst can lead to severe abdominal pain, internal bleeding, and potentially life-threatening complications 2, 3, 4, 5.
• The risk of rupture is higher for larger cysts, with studies indicating that women who underwent surgical intervention were more likely to have larger cysts 3.
• Hemorrhagic ovarian cysts are particularly concerning, as they can cause significant blood loss and lead to hemoperitoneum, a condition where blood accumulates in the abdominal cavity 2, 5.

Management of Ruptured Ovarian Cysts

• While some cases of ruptured ovarian cysts can be managed conservatively, others may require surgical intervention, particularly if there is significant bleeding or hemodynamic compromise 3, 4, 5.
• A study found that 80.8% of patients with ruptured ovarian cysts and hemoperitoneum were managed conservatively, while 19.2% required surgical intervention 5.
• Factors that increase the likelihood of surgical intervention include low diastolic blood pressure and a large amount of hemoperitoneum 5.

Potential Complications

• Ruptured ovarian cysts can lead to complications such as hypovolemic shock, which can be life-threatening if not promptly treated 2.
• Additionally, surgical intervention for ruptured ovarian cysts can impact ovarian reserve, particularly if the cyst is large or if the patient has a history of endometriosis 6.
• It is essential to carefully evaluate each patient's situation and develop an individualized management plan to minimize potential complications and preserve reproductive potential 6.