Laparoscopic management of maldescended ovary presenting with recurrent acute abdomen

Abstract

Ovarian maldescent is an extremely rare gynecological phenomenon, usually associated with Müllerian abnormalities. We report a 27-year-old woman, presenting with acute, right-sided abdominal pain. She has a history of subfertility and repeated admissions with chronic pelvic pain. Previous hysterosalpingogram and laparoscopy demonstrated unicornuate uterus with absent right fallopian tube and ovary. A right-sided, ectopic ovary was identified on later imaging and suspected as the cause of her symptoms. She underwent laparoscopic excision of the maldescended ovary with remnant fimbrial end and gubernaculum. She was discharged the following day as she was pain-free and remains so 11 months later. This case report prompts a gynecologist to consider diagnosis of maldescended ovary in the women with uterine abnormalities and repeated episodes of abdominal pain. This is the first case report to the best of our knowledge where surgical management of ovarian maldescent was performed via minimal access approach, thus avoiding laparotomy in this acute setting.

Diagnostic and Management of Undescended Ovary – A Preoperative Dilemma: A Case-Based Systematic Review

“…40 The retroperitoneal position of the ovary may lead to a higher risk of malignant changes in analogy with the undescended testis. 4,16,17,52 After searching the literature we found 4 cases of cystadenomas in UO, including our patient, but no malignant neoplasms. 38,53,54 Thus we can conclude that there is no documented association between UO and malignancy.…”

“…7 Starting from the third month of fetal life, the ovaries descend guided by the gubernaculum attached to the inferior pole. 17 The cranial part of the gubernaculum forms the proper ovarian ligament and its caudal part becomes the round ligament of the uterus. 28 The superior pole of the fetal ovary is attached to the cranial genital ligament, which becomes the infundibulopelvic ligament.…”

“…[13][14][15] The malignant potential of an UO is accepted, although no such cases have been reported. 16,17 The role of the UO in infertility is still unclear. 2,18 The aim of the present review is to provide a complete and accurate picture of this rare pathology, including documented cases from the early 20th century to the present.…”

“…upper portion of the vagina), 10 and to 42% when occurring in conjunction with controlateral UU. 5,7,14,17,31,46 Ombelet et al reported that 62.5% of patients with UU had also UO. 47 The study of Wang et al reported a UO incidence of 28% in MRKH patients compared to 5% in females with normal uterus.…”

Undescended ovary without abnormal development of uterus and urinary system: a report of four cases

“…The inherent ligaments are usually longer, while the pelvic ligaments are shorter. The ovary with these futures can be considered as undescended ovary [ 1 – 3 ].…”