Ovarian remnant syndrome (ORS) is a rare condition which results from leaving behind a part of the ovary after oophorectomy, a surgical procedure that removes one or both ovaries. The
residual tissue may cause severe pelvic pain and/or absence of menopause after oophorectomy. ORS usually presents within the first 5 years post operation.
Risk factors
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- Endometriosis is a risk factor for ORS. It is likely that due to endometriosis, ovarian tissue may become stuck to adjacent structures and missed during surgical removal leading to ORS
- Pelvic adhesions, which may limit visualization during surgery
- Bleeding during surgery
- Poor surgical technique
- Anatomic variations, such as an unusual location of the ovary
Presentation
Patients with ORS may present to the doctor most commonly with a complaint of a pelvic mass or pelvic pain. Other symptoms include:
- Continued menstruation after removal of both ovaries. The ovary produces hormones that allow the menstrual cycle to occur. When your surgeon deliberately removes the ovaries, they expect menstruation to cease. This might not happen in ORS.
- Endometriosis-like symptoms that may include painful intercourse, and urinary or bowel complaints.
Diagnosis
A history of oophorectomy is required to make a diagnosis of ORS. If suspected, a pelvic ultrasound should be performed to look for a mass.
Blood hormone levels and imaging findings can be used to clinically diagnose patients with ORS.
A definitive diagnosis necessitates surgical exploration and removal of the residual tissue.
Treatment
Symptomatic patients generally require treatment for ORS. The mainstay of treatment involves surgical removal of the remnant ovary and can be done via minimally invasive techniques. Surgery is preferred as it negates the possibility of malignant transformation of the ovarian tissue.
For patients who are not surgical candidates, hormonal therapy can be employed to suppress what is the left of the ovarian function and control symptoms.
At CEAPS, we always opt for minimally invasive approaches to provide the best experience for our patients with the least amount of side effects and complications. ORS surgery is technically challenging and requires a high level of surgical expertise.
Choose your surgeon with the training and the experience to manage these technically challenging conditions in a minimally invasive fashion.
Dr. Moawad is a highly reputable leading expert in this domain.
