Causes and clinical manifestations of complications
Ovarian tumors can remain asymptomatic for a long time, causing no complaints from the patient. Nonspecific symptoms include dull, pulling lower abdominal pain, a feeling of heaviness, and dysuric phenomena. General condition is rarely affected; however, as neoplasms grow or shift, conditions arise for the development of acute surgical emergencies.
Tumor pedicle torsion as an emergency condition
One of the dangerous complications characteristic of mature cystic teratomas (dermoid cysts) is torsion of the dermoid cyst pedicle. Such a condition triggers symptoms of an "acute abdomen," is accompanied by sharp pain, and requires immediate transfer of the patient to the operating room for emergency surgery.
Diagnostic approaches for complicated masses
The examination of patients with suspected tumor processes and their complications is based on a comprehensive approach:
- Bimanual gynecological examination to assess the mobility and contours of the mass.
- Ultrasound examination with color Doppler mapping (CDM).
- Plain abdominal radiography (effective if bone inclusions are present, for example, in teratomas).
Briefly: answers to topical questions
What anatomical structures are part of the surgical pedicle of an ovarian tumor?
The surgical pedicle of an ovarian tumor includes the structures of the anatomical pedicle and the stretched fallopian tube. It is the surgical pedicle that is ligated and transected during surgery.
What complications of benign ovarian tumors are distinguished in gynecology, besides pedicle torsion?
In addition to pedicle torsion, complications of benign ovarian tumors and cysts may include wall or capsule rupture, hemorrhage into the cavity of the mass, secondary infection (suppuration), and, for certain tumors, malignant transformation.
What is the surgical strategy and scope of surgery for ovarian tumor pedicle torsion?
The surgical strategy and scope of surgery for pedicle torsion depend on the presence of tissue necrosis.
- In case of necrosis: removal of the uterine appendages (adnexectomy) on the affected side is performed. An important rule is that the twisted pedicle must under no circumstances be untwisted.
- In the absence of necrosis (organ-preserving strategy): detorsion (untwisting of the pedicle) is performed and the recovery of blood circulation is observed. If ischemia and venous congestion disappear, the appendages are not removed, and the scope of surgery is limited to ovarian resection.
If signs of peritonitis are present, the surgery is completed by drainage of the abdominal cavity.
How does the clinical picture of complete tumor pedicle torsion differ from partial torsion?
The clinical picture depends on the degree of impaired tumor blood supply and the rate of development of torsion.
| Characteristic | Complete torsion (360° or more) | Partial torsion (less than 360°) |
|---|---|---|
| Onset of the disease | Sudden | Gradual |
| Pain syndrome | Sharp pain in the lower abdomen on the affected side | Symptoms are less pronounced, may periodically intensify or disappear without treatment |
| Associated manifestations | Nausea, vomiting, constipation, and flatulence (intestinal paresis) | Secondary changes (necrosis, hemorrhage) develop gradually against the background of impaired venous outflow |
A dermoid cyst has a long pedicle — sudden movement threatens torsion and an "acute abdomen."
Class and exam questions
Which complication most commonly develops in a dermoid cyst?
The most common complication is the torsion of the tumor pedicle, which presents with an acute abdomen picture and requires emergency surgery.
What methods are used to diagnose ovarian tumors and their complications?
Diagnostics includes clinical examination, bimanual vaginorectal/vaginoabdominal examination, ultrasound with CDM, and plain radiography if bone structures are present.
What else to study on this topic
- Pathogenesis and clinical picture of androblastoma
- Stages of defeminization and masculinization
- Morphological structure and metastasis of dysgerminoma
- Classification and microscopy of mature teratomas
- Scope of surgical interventions depending on age
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