Laparoscopic surgery for massive ovarian edema during pregnancy: A case report

Abstract

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.

Drainage by Ovarian Incision for the Treatment of Massive Ovarian Edema Torsion During Pregnancy

“…MOE occurs due to venous and lymphatic reflux abnormalities caused by partial ovarian torsion [ 7 , 8 ]. During pregnancy, reported cases are diagnosed between 11 and 32 weeks of gestation [ 4 ], and chronic vascular congestion due to gravid uterus is assumed to be responsible for some cases [ 9 ]. Its risk has also been reported to increase when lesions are present in the ovary.…”

“…MOE can be complicated by torsion, as reported in 43-59% of surgically treated cases [ 3 , 5 ]. In MOE during pregnancy, the frequency of torsion is approximately the same [ 4 ]. In contrast, reports have suggested that even during pregnancy, a conservative approach can lead to improvement, provided no symptoms are present [ 10 ].…”

“…Laparoscopic surgery can be safely performed with less stress on the mother using minimally invasive procedures [ 4 , 17 , 18 ]. Treatment options include conservative management and surgery.…”

“…Dilatation of the lymphatic vessels may also be noted. No inflammatory cell infiltration is observed in the edematous stroma [ 1 , 2 , 4 ]. In cases where the diagnosis is inconclusive, it may be essential to initially limit the intervention to biopsy alone and plan secondary treatment based on histopathological findings.…”

“…It is crucial to differentiate MOE from other ovarian tumors due to its benign nature, which makes ovary preservation, an essential aim in young or pregnant women, possible. Although the diagnosis of MOE can be made using ultrasound and magnetic resonance imaging (MRI) with its characteristic findings, its rarity makes diagnosis difficult, often leading to overtreatment such as oophorectomy [ 4 , 5 ]. For the treatment of MOE torsion, detorsion of the ovary is essential to relieve pain, and drainage of the edema is expected to occur in time, since the obstruction is released anatomically.…”