I suddenly had abdominal pain after turning over. It turned out that it was the cause.

This is the 4777th article of Da Yi Xiao Hu

Xiaolan is 16 years old. This morning, she woke up and turned over in bed. Suddenly, she had persistent pain in the right lower abdomen, accompanied by cold sweat, nausea, and anal urge to defecate. She thought it was the stool that was causing the problem, but the abdominal pain did not ease after defecation. Seeing Xiaolan's painful face, her mother gave her a tablet of Sanlitong and hurriedly brought her to the emergency department of our hospital. After a series of examinations, it was found that it was not an internal medicine disease, but a gynecological disease. The family and the girl were very surprised to learn of this result. The little girl usually had normal menstruation and had never had sex. How could she have a gynecological disease? It turned out that it was this that was causing the problem - the ovarian tumor had a torsion of the pedicle.

For unmarried or younger women, when menstruation is normal, they rarely pay attention to whether they have reproductive tract diseases. Even if they do physical examinations, they are likely to ignore the examination of the female reproductive tract. The occurrence of ovarian tumors has no direct relationship with menstruation or sexual life. In young women who do not have sexual life, ovarian tumor pedicle torsion is one of the common causes of gynecological acute abdomen, and most of them are benign tumors.

1. Why do young women get ovarian tumors?

In fact, ovarian tumors can occur in women of all ages, but the histological types may be different. Ovarian tumors can be roughly divided into epithelial tumors, germ cell tumors, sex cord stromal tumors and metastatic tumors. Epithelial tumors are more common in women aged 50 to 60, while ovarian germ cell tumors are more common in young women under 30. Although ovarian tumors can be divided into benign, malignant and borderline, benign tumors are more common in young women. The cause of ovarian tumors is still unclear, and may be related to genetic and environmental factors.

2. How to detect ovarian tumors early?

For ovarian tumors, the clinical compliance rate of B-mode ultrasound examination can be greater than 90%. Therefore, for young women, even if they do not have sexual life or have normal menstruation, B-mode ultrasound examination of the uterus, adnexa and pelvis can be added during the annual physical examination.

3. Why does ovarian tumor pedicle torsion occur?

When the patient changes her body position suddenly, such as turning over or doing strenuous exercise, ovarian tumors with long pedicles, good mobility, medium size and center of gravity on one side will experience pedicle torsion as the body position changes, with the amplitude mostly between 180 and 720 degrees. In addition, for women during pregnancy and postpartum period, changes in the size and position of the uterus may also easily lead to pedicle torsion of ovarian tumors.

4. Why does ovarian tumor pedicle torsion cause severe lower abdominal pain?

The pedicle of ovarian tumor torsion is composed of the pelvic infundibulocytic ligament, the ovarian proper ligament and the fallopian tube. Acute torsion can lead to obstruction of venous return, congestion or intratumoral bleeding of the tumor, increase in tumor tension and volume, and even rupture or secondary infection. At the same time, torsion can cause peritoneal traction and strangulation. Therefore, patients may experience sudden severe pain in one side of the lower abdomen, often accompanied by nausea, vomiting and even shock.

5. Does ovarian tumor pedicle torsion necessarily require surgery?

Once the ovarian tumor pedicle is considered torsion, surgical exploration should be performed in time. If the torsion time is short and the torsion amplitude is small, and there is no ischemic necrosis or thrombosis, repositioning and ovarian cyst removal can be considered to preserve normal ovarian tissue. Once ischemic necrosis or thrombosis is found, the tumor and the torsion pedicle should be removed together, and the torsion should not be repositioned before resection to prevent the embolism from falling off. Of course, whether to preserve the ovaries should also be considered in combination with the patient's age, whether there is a desire to have children, and the benign or malignant nature of the tumor. For young patients who have fertility requirements and whose tumors are considered to be benign, they should be preserved as much as possible if conditions permit. For older women who are close to menopause, have no fertility requirements, or are postmenopausal, direct resection can be considered regardless of the benign or malignant nature of the tumor.

Conclusion

Regardless of whether it is acute abdominal pain caused by ovarian tumor pedicle torsion or acute abdominal pain caused by other reasons, you should avoid taking painkillers without authorization before the cause is clear, so as to avoid the abdominal pain being relieved under the effect of the medicine but easily masking the true condition and delaying diagnosis and treatment.

Author: Department of Gynecology, Huadong Hospital, Fudan University

Zhu LihongDeputy Chief Physician