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Chapter 14 - Pelvic Pain Arising from Ovarian Remnant Syndrome

Published online by Cambridge University Press:  08 March 2021

Michael Hibner
Affiliation:
St Joseph’s Hospital & Medical Center, Phoenix, AZ
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Summary

Ovarian remnant syndrome occurs in patients who have had attempted oophorectomy and part of the ovary was left behind. It often happens in patients who are undergoing total abdominal hysterectomy with bilateral salpingo-oophorectomy in the setting of severe pelvic adhesions. In those cases, the surgeon, to avoid injury to the ureter, which is not well visible, clamps gonadal vessels too close to the ovary and some ovarian tissue remains in the patient. The patient often experience severe, sharp unilateral pelvic pain that is cyclical in nature. On ultrasound there is often a cystic adnexal mass but lack of a mass does not rule out an ovarian remnant. Hormonal assays may also be helpful. Treatment is surgical but surgery for this condition may be overly difficult because the original surgery to remove the ovary was most likley difficult in the first place. Procedures to remove ovarian remnants should be performed only by highly qualified providers who are experienced in operating in the setting of severe adhesions. On a positive note, patients in whom ovarian remnant was successfully removed are almost always cured of their pain.

Type
Chapter
Information
Management of Chronic Pelvic Pain
A Practical Manual
, pp. 150 - 155
Publisher: Cambridge University Press
Print publication year: 2021

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References

Webb, MJ. Ovarian remnant syndrome. Aust N Z J Obstet Gynaecol. 1989;29(4):433–5.CrossRefGoogle ScholarPubMed
Arden, D, Lee, T. Laparoscopic excision of ovarian remnants: retrospective cohort study with long-term follow-up. J Minim Invasive Gynecol. 2011;18(2):194–9.Google Scholar
Chao, HA. Ovarian remnant syndrome at the port site. J Minim Invasive Gynecol. 2008;15(4):505–7.CrossRefGoogle ScholarPubMed
Shemwell, RE, Weed, JC. Ovarian remnant syndrome. Obstet Gynecol. 1970;36(2):299303.Google ScholarPubMed
Cruikshank, SH, Van Drie, DM. Supernumerary ovaries: update and review. Obstet Gynecol. 1982;60(1):126–9.Google ScholarPubMed
Elkins, TE, Stocker, RJ, Key, D, McGuire, EJ, Roberts, JA. Surgery for ovarian remnant syndrome: lessons learned from difficult cases. J Reprod Med. 1994;39(6):446–8.Google ScholarPubMed
Abu-Rafeh, B, Vilos, GA, Misra, M. Frequency and laparoscopic management of ovarian remnant syndrome. J Am Assoc Gynecol Laparosc. 2003;10(1):33–7.Google Scholar
Magtibay, PM, Magrina, JF. Ovarian remnant syndrome. Clin Obstet Gynecol. 2006;49(3):526–34.Google Scholar
Podgaec, S, Abrao, MS, Dias, JA Jr, Rizzo, LV, de Oliveira, RM, Baracat, EC. Endometriosis: an inflammatory disease with a Th2 immune response component. Hum Reprod. 2007;22(5):1373–9.Google Scholar
Kho, RM, Abrao, MS. Ovarian remnant syndrome: etiology, diagnosis, treatment and impact of endometriosis. Curr Opin Obstet Gynecol. 2012;24(4):210–14.Google Scholar
Nezhat, F, Nezhat, C. Operative laparoscopy for the treatment of ovarian remnant syndrome. Fertil Steril. 1992;57(5):1003–7.CrossRefGoogle ScholarPubMed
Fennimore, IA, Simon, NL, Bills, G, Dryfhout, VL, Schniederjan, AM. Extension of ovarian tissue into the infundibulopelvic ligament beyond visual margins. Gynecol Oncol. 2009;114(1):61–3.CrossRefGoogle ScholarPubMed
Magtibay, PM, Nyholm, JL, Hernandez, JL, Podratz, KC. Ovarian remnant syndrome. Am J Obstet Gynecol. 2005;193(6):2062–6.CrossRefGoogle ScholarPubMed
Kho, RM, Magrina, JF, Magtibay, PM. Pathologic findings and outcomes of a minimally invasive approach to ovarian remnant syndrome. Fertil Steril. 2007;87(5):1005–9.Google Scholar
Imai, A, Matsunami, K, Takagi, H, Ichigo, S. Malignant neoplasia arising from ovarian remnants following bilateral salpingo-oophorectomy (Review). Oncol Lett. 2014;8(1):36.CrossRefGoogle ScholarPubMed
Johns, DA, Diamond, MP. Adequacy of laparoscopic oophorectomy. J Am Assoc Gynecol Laparosc. 1993;1(1):20–3.Google ScholarPubMed
Dmowski, WP, Radwanska, E, Rana, N. Recurrent endometriosis following hysterectomy and oophorectomy: the role of residual ovarian fragments. Int J Gynaecol Obstet. 1988;26(1):93103.Google Scholar
Fat, BC, Terzibachian, JJ, Bertrand, V, Leung, F, de Lapparent, T, Grisey, A, et al. Ovarian remnant syndrome: diagnostic difficulties and management. Gynecol Obstet Fertil. 2009;37(6):488–94.Google Scholar
Magrina, JF, Lidner, TK, Cornelia, JL, Lee, RA. Cyclic vaginal bleeding after total hysterectomy. J Pelvic Surg. 1998;4(2):62–6.Google Scholar
Kaminski, PF, Meilstrup, JW, Shackelford, DP, Sorosky, JI, Thieme, GA. Ovarian remnant syndrome, a reappraisal: the usefulness of clomiphene citrate in stimulating and pelvic ultrasound in Locating Remnant Ovarian Tissue. J Gynecol Surg. 1995;11(1):33–9.Google Scholar
Narayansingh, G, Cumming, G, Parkin, D, Miller, I. Ovarian cancer developing in the ovarian remnant syndrome: a case report and literature review. Aust N Z J Obstet Gynaecol. 2000;40(2):221–3.Google Scholar
Mahdavi, A, Kumtepe, Y, Nezhat, F. Laparoscopic management of benign serous neoplasia arising from persistent ovarian remnant. J Minim Invasive Gynecol. 2007;14(5):654–6.Google Scholar
Donnez, O, Squifflet, J, Marbaix, E, Jadoul, P, Donnez, J. Primary ovarian adenocarcinoma developing in ovarian remnant tissue ten years after laparoscopic hysterectomy and bilateral salpingo-oophorectomy for endometriosis. J Minim Invasive Gynecol. 2007;14(6):752–7.Google Scholar
Rossing, MA, Cushing-Haugen, KL, Wicklund, KG, Doherty, JA, Weiss, NS. Risk of epithelial ovarian cancer in relation to benign ovarian conditions and ovarian surgery. Cancer Causes Control. 2008;19(10):1357–64.Google Scholar
Chan, TL, Singh, H, Benton, AS, Harkins, GJ. Ovarian artery embolization as a treatment for persistent ovarian remnant syndrome. Cardiovasc Intervent Radiol. 2017;40(8):1278–80.Google Scholar

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