Ovarian Remnant

I recently saw a patient who has struggled with pelvic pain for years. She has undergone numerous surgeries and treatments. She most recently had a laparoscopic supracervical hysterectomy (LSH) with removal of her tubes and ovaries. She was noted to have endometriosis at that time.

She presented to me with concerns over continued, worsening pain. She was being seen by a pain specialist and enrolled in a pain management program. Her pain affected many areas of her life. She struggled to work, be a mother, and a wife.

Her symptoms consisted of general pelvic pain which was sharp and debilitating. She also had pain with intercourse or dyspareunia.

During her surgery she was found to have her sigmoid colon attached to the side of her pelvis. This is called adhesions. The bowel was densely adhered to the pelvic sidewall and continuing down to and involving half of the area of her cervical stump.

As I began dissecting out the adhesions it became evident that a small portion of her ovary had been left behind with her previous surgery. This is known as “Ovarian Remnant Syndrome.” When a small piece of ovary is left behind due to difficult adhesions or other reasons, the ovary begins to grow in an invasive nature. It seeks out a new blood supply and in doing so invades into surrounding structures.

This patient had her ovary growing into the pelvic sidewall, completely encasing her ureter. It was also growing into the bowel wall.

During her surgery the ureter was identified high in the pelvis and carefully dissected along its course. As I approached the area of the ovary it became evident that it was “stuck” to the underlying structures. Using careful laparoscopic dissecting techniques, the ureter was unroofed and the adhesions were cleared off. The residual ovary was then dissected deeply and removed. A portion in the bowel wall was also removed.

At the end of the surgery, cystoscopy was performed to check the integrity of the bladder and ureter. I also perform a bowel integrity test any time there is concern for possible bowel injury.

I have hopes that removing the residual ovary will allow her more ability to do the things she likes to do and be the mother she wants to be.