Massive ovarian edema (MOE) is a rare non-neoplastic clinicopathologic disease that is characterized by stromal edema and is caused by the partial or intermittent obstruction of venous and lymphatic drainage. The literature on MOE contains approximately 200 cases, but only 12 cases of MOE during pregnancy have been reported to date. We report a case of MOE at 22 weeks of gestation that was diagnosed preoperatively, and the patient underwent laparoscopic surgery. Accurate preoperative diagnosis of MOE is important because it enables the selection of a therapeutic option, such as fundamental surgery, including adnexectomy; conservative surgery, including the release of torsion and ovarian biopsy; and conservative treatment without surgery. MOE should be considered as a differential diagnosis for an enlarged ovary during pregnancy. Laparoscopic surgery may be a useful therapeutic option for MOE, especially during pregnancy.

Objective: We investigated the effectiveness of switching cefazolin (CEZ) to cefmetazole (CMZ) for preoperative antimicrobial prophylaxis and the role of preoperative vaginal preparation using normal saline to reduce vaginal cuff infectious morbidity after total laparoscopic hysterectomy (TLH).Methods: We retrospectively investigated 1476 patients who underwent TLH at our hospital between April 2010 and December 2020. The vaginal cuff infectious morbidity and the causative bacteria were analyzed. The CEZ group included 1095 women who received a preoperative intravenous drip injection of CEZ, the CMZ group included 221 women who received a preoperative intravenous drip injection of CMZ, and the vaginal cleaning group included 160 women who received a preoperative intravenous drip injection of CMZ and additionally underwent preoperative vaginal preparation using normal saline. We analyzed post-TLH data to determine the causative bacteria associated with vaginal cuff infection.Results: Postoperative vaginal cuff infection occurred in 2.38%, 2.26%, and 1.25% of women in the CEZ, CMZ, and the vaginal cleaning groups, respectively. Intergroup comparison did not show a significant difference in vaginal cuff infectious morbidity. The causative bacteria associated with post-TLH vaginal cuff infection predominantly belonged to the Enterococcus species (10/38 cases). Conclusion:Our study showed no significant intergroup difference in vaginal cuff infectious morbidity; however, further studies are warranted to conclusively establish the effectiveness of preoperative vaginal preparation using normal saline.

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