Abstract
Background: Ovarian remnant syndrome (ORS) is characterized by functional ovarian tissue following bilateral salpingo-oophorectomy. ORS presents with pelvic pain or mass, but may also present with urinary tract symptoms resulting from enlarging residual tissue. Case: A 37 year old woman presented with pelvic pain radiating to her flank due to ureteral obstruction from an enlarging ovarian cyst in ORS. Transvaginal ultrasound guided, ovarian cyst aspiration accompanied by leuprolide acetate gonadotropin suppression resulted in acute and chronic relief of ureteral obstruction. Conclusion: This case demonstrated successful treatment of ureteral obstruction caused by an ovarian cyst in a patient with ORS via cyst aspiration and leuprolide acetate gonadotropin suppression. This treatment is a viable alternative for management of ORS, but sacrifices pathologic diagnosis when compared to traditional surgical resection.
Highlights
Ovarian remnant syndrome (ORS) is defined as functioning ovarian tissue left inadvertently at the time of bilateral salpingo-oophorectomy (BSO) and has been associated with pelvic pain, a mass, or ureteral obstruction [1]
This case demonstrated successful treatment of ureteral obstruction caused by an ovarian cyst in a patient with ORS via cyst aspiration and leuprolide acetate gonadotropin suppression
This treatment is a viable alternative for management of ORS, but sacrifices pathologic diagnosis when compared to traditional surgical resection
Summary
Ovarian remnant syndrome (ORS) is defined as functioning ovarian tissue left inadvertently at the time of bilateral salpingo-oophorectomy (BSO) and has been associated with pelvic pain, a mass, or ureteral obstruction [1]. Follicle Stimulating Hormone (FSH) levels may be helpful in the diagnosis of ORS with premenopausal levels in a woman following BSO suggestive of the presence of functional remnants of ovarian tissue [1]. On the other hand, elevated FSH levels do not rule out ovarian remnant syndrome In this case clomiphene citrate or a GnRH agonist may assist in making the diagnosis by stimulating residual ovarian fragments and make them easier to identify on imaging or at surgery [5]. The definitive diagnosis of ORS is made with the pathological confirmation of residual ovarian tissue at a subsequent surgery following BSO. The purpose of this case study is to describe an alternative, minimally invasive method for treating ORS, with transvaginal ultrasound guided cyst aspiration accompanied by gonadotropin suppression with leuprolide acetate
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