A case of residual ovarian syndrome with classic symptoms
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Residual ovarian syndrome (ROS) occurs after a hysterectomy in which one or both ovaries have been preserved and cause chronic pelvic pain, an asymptomatic pelvic mass, or dyspareunia. The present case has been reported in the Taiwanese Journal of Obstetrics and Gynecology.

A 35-year-old woman was regularly followed at the outpatient Department of Gynecology due to menorrhagia and severe dysmenorrhea for 2 years. Accordingly, laparoscopic-assisted vaginal hysterectomy was performed 20 months prior due to persistent symptoms. The histology of the operative specimen confirmed uterine adenomyosis.

Both ovaries appeared normal during the operation. She subsequently presented to the outpatient Department of Gastroenterology and Hepatology due to left lower abdominal pain for 4 months. Abdominal computed tomography showed a 3.8-cm cystic mass with debris deposition over the right hemipelvis. An ovarian cyst was suspected.

She was referred to the outpatient Department of Gynecology, where transvaginal ultrasound revealed a well-defined, homogeneous hypoechoic 2.51 × 1.66-cm cystic lesion in the right adnexa without blood flow; the left adnexa had no abnormal findings. After 2 months of treatment, her left lower quadrant abdominal pain persisted.

A diagnosis of ROS was made and the treatment plan included observation with painkillers. Her lower abdominal pain and ovarian cyst persisted after 3 months of follow-up. Due to intractable pain she was admitted for surgical intervention. Laparoscopy was performed and a 4 × 4-cm right ovarian cyst was found. Right ovarian cystectomy was performed.

Due to intractable pelvic pain in the left adnexa, left salpingo-oophorectomy was performed after thorough discussion. There were no adhesions in the pelvis and abdomen. Histology confirmed a cystic follicle in the left ovary and a hemorrhagic corpus luteum cyst in the right ovary. The patient made an uneventful recovery and was discharged home 2 days later. She was well at her 12-month postoperative check-up

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