Twisted tumor of the ovary (cyst, cistema) and pregnancy

There are two forms of ovarian tumors: stalked (at the bottom) and mismatching developing between the pieces of the broad ligament.
Mismatches cysts are distinguished by their immobility. They are relatively rare; more frequent tumors, soldered to the back piece of the broad ligament, the so-called pseudodistance tumors.
From a clinical point of view of more practical value has stalked, form (a tumor of the ovary is developing in the direction of free abdominal cavity), which is often twisted legs tumors and sometimes even its complete tsorona. Tumor appendages are found in patients in 0.1-0.5% and 60% of cases are among termodov (K. K. Skrobanski).
In leg ovarian tumors include: the mesentery of the ovary, own a bunch of ovarian, uterine the end of the oviduct, Vorontsov ligament and blood vessels (arteries and veins)that feed the tumor. In a twisted leg sometimes involved gland and intestines. With the growth of the tumor leg usually thickens and is extended, sometimes substantially. Move and rotate the tumor in the abdominal cavity connected with twisted legs tumor torsio pedunculi from 90 to 360 degrees and more.
The longer leg, the more favorable conditions for moving tumors of the small pelvis in a large, along with the more powerful twist it.
Moving tumors of the small pelvis in a large can cause tightening of the uterus up that often leads to miscarriage. Concurrently with this shift loops of bowel and seal.
which is why when a sharp rotational movements of the body patient (dancing, gymnastics and others) there are conditions for turning legs around its own axis. When you stop the rotational motion of a body rotation of a tumor, especially if the content of its liquid, continues in force of inertia in the original direction, which leads to twisting. Twisting the tumor is also facilitated the movement of the body of the patient from horizontal to vertical.
Factors contributing to the twisting legs are asymmetrical shape and non-uniform (one-sided), the growth of the tumor itself, its value, the difference of pressure in the vessels of the legs, swelling (hemodynamic twisting). Twisting favors intestinal peristalsis, the change in intra-abdominal pressure, the presence of a pregnant uterus, and so on, Twisting can
The degree of mobility due to the size of the tumor and long legs. In some cases, the tumor is so driven to the pelvis that is not possible to bring it out even under anesthesia; when chrevosechenie this tumor is displayed easily. Impacted ovarian cysts can pose obstacles to the birth of a fetus as large fibroids uterine located on the way of promotion of the fetus through the birth canal (Fig. 72, 73).


Fig. 72. In kolotushas cyst - obstacle for the birth of a fetus.

Fig. 73. Submucosal fibroids is a barrier to the delivery.

The mechanism twist legs tumors can be understood from the point of view of the law of inertia. Leg, as a rule, is not suited to the center of the tumor,
be preceded by the formation of adhesions and growths of neighboring organs from stem tumors (72%).
Perekrashivat as solid and racemose tumors; from racemose often perekrashivat single chamber.
Malignant tumors perekrashivat less benign view of the tendency to the formation of growths.
Frequency kinks ranges from 15 to 20% with respect to, the number of all stalked tumors.
Simultaneous bilateral twisting cysts is rare. Twisted legs left of the tumor is usually clockwise, and the right counterclockwise.
The age of patients who have observed the phenomenon of having turned too far, various, but mostly it is women zagorodnogo age. Noted that the twisting is more likely to occur in parous.
With twisted legs are normally disturbed blood supply to the tumor, the first compressed thin veins, not the arteries. As a result, the size of the tumor grows and becomes the color of her dark purple or violet, and eventually brown. Under the influence of hemorrhage into the tumor often break the wall with the outpouring of the contents into the abdominal cavity. Occurs exudative peritonitis, festering or eliminate the tumor. In some cases, twisted the tumor can absolutely work loose ("free body"). Frequency ethnorepublics to istom ovarian varies from 1.2% (Grotenfeld) to 2.8% (Vogt) in relation to all cases twisted legs of the tumor. On the material of our clinic on 1212 transactions made on the occasion of cysts and custom ovary and proofreading cysts, full tsorona ovarian was observed twice (1,18% in relation to the number of all cases twist legs ovarian tumors, which was 13.9% in foreign confessions of Vachnadze).
Separated tumor of the ovary can be learnt by the gland or the mesentery and continue to develop at the expense of their blood supply.
A woman is often unaware of the presence of an ovarian tumor (cysts or cistemy), as the latter often occurs almost asymptomatic; only with twisted legs tumor appears abdominal pain and other symptoms.
The development of symptoms is in direct proportion to the degree twist legs (partial, full, multiple) and the speed at which it occurs. In cases where the twisting resulted in complete violation of tumor blood supply, the clinical picture is especially heavy. Sharp abdominal pain accompanied by flatulence, pulse Ochsen, there nausea, and sometimes vomiting. Often, the patient develops a state of collapse,
Often phenomena twist pass, and the condition of the patient improves. Further twisting reappear these symptoms, and clinical picture becomes even more difficult. Therefore, if you suspect a twisting legs tumor patient should be immediately sent to hospital.


The clinical picture. Phenomena twist usually occur suddenly after any physical strain; less often they are increasing gradually.
The clinical picture is very similar to that for ectopic pregnancy: severe abdominal pain, flatulence, delay defecation. Notes nausea, sometimes vomiting, pulse Ochsen and weak filling. Sometimes loss of consciousness. Body temperature is usually increased, often chills, in some cases, the temperature reaches 40 degrees, and develops a picture of acute peritonitis.
Sometimes when twisting legs tumors of the ovary occurs bleeding from the uterus. If the pregnancy causes twisting abortion, postpartum - heavy septic condition. The attack continued for several days. The intervals between attacks range from several days to several months.
Quite different is represented clinical picture in gradually developing twisting. In these cases, the symptoms are expressed less sharply; pain in the abdomen limited to twist it. Pulse although Ochsen, but relatively satisfactory filling. The body temperature rises gradually.
The long existence twist legs tumor leads to the development of adhesive peritonitis; in these cases, the temperature fluctuates within 38-39 degrees.
Temperature increases significantly if the cyst infection of the intestines, through the blood or lymph. The consequence of infection is often paralysis intestinal, and the patient may die; in addition, there are cases when the temperature falls and the patient recovers. Long increased heart rate when remitting temperature indicates a festering content cysts.
In some cases, there can be rotated legs tumors of the ovary, the pain slowly subsided, and the phenomena of peritonitis are liquidated. More common is the formation of growths cysts with other organs and tissues that causes constant pain in the abdomen.
Diagnosis of twisting of an ovarian tumor is not always easy. It is even more difficult in advance to make a diagnosis adsorbates tumor, it usually put in operation. Often quite unexpectedly, only on the operating table, find sharply twisted leg of the tumor, whereas the clinical picture about this said nothing. The differential diagnosis should be borne in mind appendicitis, intestinal obstruction, lobby - or nephrolithiasis, ectopic pregnancy, etc. Under these diagnoses the patient with "twisted cyst is adjudged to be in the order of emergency on the operating table.