A case of massive ovarian edema (MOE) treated with laparoscopy

Abstract

Massive ovarian edema (MOE) was first described by Kalstone et al. in 1969 as a“massive, solid enlargement of the ovary associated with interstitial edema, without neoplastic change.”A literature review revealed>100 reported cases, and although most of the patients were young, they usually underwent removal of the affected ovaries. We report a case involving a 23-year-old woman admitted to our department with sudden right lower abdominal pain. The ultrasonographic study showed an enlarged right ovary, approximately 6 cm in diameter, with multiple small low echoic lesions. A CT scan showed no malignant features of this mass. With a preoperative diagnosis as MOE with right adnexal torsion, we performed a laparoscopy. As we had expected, the right adnexa was twisted and the right ovary was gray and swollen. Within 10 minutes of detorsion, we noted that the color of the ovary had improved. Postoperatively, she was pain-free and began taking oral contraceptives to diminish the size of the ovary. Eight months after the surgery, the ovary was near-normal in appearance by an ultrasonographic study and there has been no recurrence of pain. Since there are very few cases of young women with neoplasms, to avoid the unnecessary removal of the ovary, we should suspect MOE when we care for young women with abdominal pain and a solid, enlarged ovary. Although there is no established treatment for MOE, laparoscopy is a powerful diagnostic tool. Moreover, oral contraceptives postoperatively may be effective in preventing the recurrence of MOE.