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Date of last update: 10/14/2017.

Forum Name: Gynecology

Question: Chemical Peritonitis from Ovarian Cyst

 krazykat - Sun Feb 18, 2007 12:40 pm

Last month I was diagnosed with a ruptured ovarian cyst which caused chemical peritonitis. I only saw a nurse practitioner and she just did an external exam. I was told to take Ibuprofen and anti-inflammatory supplements, and that if it kept happening I might have to go on the pill to stop ovulation. It is happening again this month, starting with strong left side ovary pain, and then spreading into a burning pain that radiates all across my pelvis and and throughout my abdomen, all the way up to the bottom of my ribcage. The burning feels like a bad sunburn inside my body--I was told this was chemical peritonitis from fluid from the cyst.

Last month this lasted for ten days, and the pain didn't really stop until my period started, after which I was okay until it all started over this week, again beginning with the left ovary pain. I am concerned that this time I am taking lots of Ibuprofen (three or four tablets three times a day) and it doesn't seem to even touch the peritonitis pain. I made an appointment to see an OB/Gyn after the last episode, but that appointment is still not for two weeks. Is this potentially urgent, and is there anything else that can or should be done about the chemical peritonitis?

I have a low fever and chills, but no nausea, vomiting or other bowel symptoms. I am 41 years old, have never been pregnant, and have always had a very regular cycle, only occasionally having mild ovarian pain in the middle of my cycle. Over approximately the last six months I have felt ovary twinges several times, and they have always been on the left side.
 Dr. Leigh Anderson - Sun Feb 18, 2007 1:40 pm

User avatar Hi KrazyKat,

The diagnosis you were given, was it a direct find from an ultrasound ? If not then it is almost impossible to say that is what your problem is.

There are many organs in the abdomen. Pain in the abdomen can originate from any one of them, including:

However, the pain may originate from somewhere else -- like your chest or pelvic region. You may also have a generalized infection affecting many parts of your body, like the flu or strep throat.

The intensity of the pain does not always reflect the seriousness of the condition causing the pain. Severe abdominal pain can be from mild conditions, such as gas or the cramping.

When an inflamed organ in the abdomen ruptures or leaks fluid, you not only have excruciating pain, your abdomen will be very stiff (board-like) and you will likely have a fever. This occurs when you have peritonitis due to an infection spreading in the abdominal cavity from the ruptured organ, like the appendix. This is a medical emergency.

Abdominal pain that occurs during menstruation may be from menstrual cramps or it may indicate a problem in a reproductive organ. This includes conditions such as endometriosis (when tissue from the uterus is displaced to somewhere else like the pelvic wall or ovaries), uterine fibroids (thick bands of muscular and fibrous tissue in the uterus), ovarian cysts, ovarian cancer (rare), or pelvic inflammatory disease (PID) -- infection of the reproductive organs, usually from a sexually transmitted disease.
 krazykat - Sun Feb 18, 2007 3:02 pm

Dr. Anderson -

Thank you for your reply. No, I did not have an ultrasound, only an external exam. As I understand it, she made the determination based on the fact that when she pressed down on my left ovary it was extremely painful, and based on my description of the symptoms. Both times the pain definitely started with the ovary and then spread from there. It is also clearly tied to my cycle, because it went away completely for part of the month and came back in the same way.

It is not pain associated with menstruation in any way since when my period started is when the pain stopped.

I am still worried and puzzled as to whether it should be okay to wait two weeks for the OB/Gyn appointment I already have scheduled, or whether I need to do something drastic like go to the ER . . .
 krazykat - Sat Mar 03, 2007 11:51 am

Since I posted this question here I just wanted to relate what I learned from my OB/Gyn, in case anyone else is dealing with this issue or would just like to learn more about it, as I've found very little info on it. (And the reply posted here was very general and didn't explain the specific topic.)

All I'd been able to learn from the Internet was that chemical peritonitis from an ovarian cyst was an exception in several ways to all other kinds of peritonitis--specifically, that it was the one kind of peritonitis that is generally not a life-threatening emergency, usually doesn't require surgical intervention, and that it is the only kind of peritonitis that doesn't have any long-term effect.

My OB-Gyn confirmed this, and explained how it results from the normal process of ovulating, in which one of several follicles which develop on the ovaries bursts open to release the egg, also releasing fluid into the peritoneum (the lining of the abdomenal cavity.) Normally the body just absorbs the fluid, and you don't even feel it. For some women, however, the normal rupture of the follicle causes pain, and sometimes the fluid that is released also causes inflamation--that is, chemical peritonitis--which is painful.

I had always understood that 'meddelschmertz'--the term for pain in the middle of your cycle--was just the pricking, tugging sensation, sometimes with a bit of a lingering ache, that I'd experienced a few times myself. However, my doctor said that the term also refers to intense pain from the rupture of the follicle, and/or pain from chemical peritontis caused by the fluid spreading inside your body, and that some women have this a lot! And you may go for years without it causing pain and then start to feel it every month . . .

Also, what can make the chemical peritonitis really bad is if there is bleeding when the follicle ruptures, because blood anywhere in your body outside of the blood vessels where it normally travels is extremely irritating to the tissues. However, it doesn't actually harm you, even if it hurts a lot. (And the best way to describe my experience is that it feels like a severe sunburn inside your body!) It's essentially just like a bruise; the blood is slowly reabsorbed, and it doesn't cause scarring or any other tissue damage.

The nurse practictioner I saw implied that having fluid and blood causing inflammation was some cause for concern, and that it meant you had a lot of free-radicals floating around, which can cause other problems (one of the things she recommended was taking high doses of vitamin C.) But my OB/Gyn said that although it's unsual for it to cause so much pain, all of this still falls within the realm of a 'normal' process!

The only thing that can be done about it--which is what I'm doing now--is to go on the pill to stop ovulation for a while, so that the irritation and inflamation in the ovary/follicles, possibly including bleeding from the ruptured follicle, will hopefully heal up and resolve.

Incidentally, one thing I've noticed in trying to find out more about this is that some doctors get really annoyed when the term 'cyst' is used for the follicle that develops (getting as big around as a quarter before it ruptures!), implying that it's some kind of unnatural growth on the ovary, when it really isn't--it's just what ovaries always do . . . Hope this helps clears up this topic for anyone out there who might also have had questions about it . . .

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