Ovarian remnant syndrome

Specialty: Gynecology and breast.

• Painful residual ovarian tissue
• post-oophorectomy ovarian rest syndrome
• pelvic pain due to ovarian remnant

Why it occurs

• Presence of a fragment of ovarian tissue left inadvertently during a previous oophorectomy (common in complex surgeries with severe adhesions due to endometriosis or PID), which revascularizes, proliferates under the stimulus of elevated pituitary gonadotropins and forms cysts or painful inflammatory foci in the pelvis

Initial workup

Transvaginal or abdominal gynecological ultrasound (shows an image compatible with ovarian parenchyma with follicles or cysts in the space of the previously surgical ovarian fossa). Determination of serum levels of estradiol and FSH (detectable estradiol levels associated with FSH that are not in the castration or postmenopausal range confirm the presence of active functional ovarian tissue). Pelvic MRI with contrast to delineate the remnant with respect to the ureters and iliac vessels.

Standard management

• Continuous combined contraceptives or GnRH analogues (Triptorelin 3.75 mg IM monthly) to drastically suppress gonadotropin levels (FSH, LH) and cause atrophy of the remaining ovarian tissue, reducing follicular volume and pain. If suppressive medical therapy fails, pain persists or there is ureteral compromise, laparoscopic surgical removal of the remaining tissue is indicated, which is highly complex and requires prior localization of the ureter through intraoperative ureteral catheterization (note: the use of markers such as indocyanine green helps with vascular localization of the residual tissue).