Bilateral Herniation of the Ovaries into the Anterior Compartment of the Pelvis

Abstract

A 41-year-old woman had a 6-month history of pelvic pain and heavy periods. She had no significant gynecologic or surgical history. Pelvic ultrasonography revealed a large complex cyst measuring 5.1 ! 5.4 ! 5.4 cm within the right adnexa (Fig. 1). CA 125 was minimally increased at 44. During laparoscopy, both ovaries were found to have herniated through the broad ligament into the anterior compartment. The round and ovarian ligaments had their usual attachments to the uterus. Bilateral ovarian cysts were observed, both approximately 5 cm in greatest diameter. The right ovary was densely adherent to the pelvic side wall. No other pelvic or upper abdominal disease was noted. A perioperative diagnosis of bilateral ovarian endometrioma was made. Laparoscopic right salpingo-oophorectomy and left ovarian cystectomy were performed with the ovaries in their abnormal location. Histologic analysis confirmed endometriotic cyst in the right ovary and hemorrhagic corpus luteum in the left ovary. Defects in the broad ligament can be congenital or acquired. Acquired defects can result from pelvic surgery, pregnancy, or pelvic inflammatory disease. Although herniation of bowel through the broad ligament has been described [1–4], to our knowledge, there are no reports of bilateral ovarian herniation through defects of the broad ligament.