Ovarian Remnant Syndrome at the Trochar Site: A Report of a Rare Complication Following Laparoscopic Ovarian Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Ovarian surgery can leave behind ovarian tissue and this residual ovarian tissue may eventually cause pelvic pain and/or the formation of a mass. The term " ovarian remnant syndrome " has been used to describe this condition. 1 Ovarian remnant syndrome usually occurs as a result of improper tissue removal or an inappropriate blunt dissection. Endometriosis, pelvic inflam-matory disease or previous gynecologic surgeries have been known to increase the risk. Such conditions make removal of ovarian tissue difficult, due to the increased likelihood of dense fibrotic adhesions between an ovary and surrounding structures. Furthermore, with an increase in the number of laparoscopic ovarian surgeries performed, implantation of ovarian tissue also has been recognized as an important cause of ovarian remnant syndrome. 2 Various locations have been identified where residual ovarian tissue was detected after laparoscopic ovarian surgery, including the pelvic wall, cervix, vagina, and bladder. 1 However, reports of residual ovarian tissue detected in an abdominal wall have been rare. This report describes a case of ovarian remnant syndrome caused by residual ovarian tissue at the trochar site after a laparoscopic ovarian cystectomy. A 35-year-old woman presented with an abdominal wall mass that was palpable one week prior to her visit. The mass was not painful and did not show a change in size. Her past medical history was remarkable because she had undergone laparoscopic bilateral ovarian cystectomy due to endometriosis 3 years prior to her visit. Physical examination revealed a surgical scar on her left lower abdomen and an index finger tip-sized mass was palpable in the abdominal wall under the scar. It was smooth and movable, and was not tender. The laboratory findings were un-remarkable. Ultrasonography demonstrated an approximately 1.6×0.9 cm-sized hypoechoic mass in the subcutaneous adipose tissue (Fig. 1). An excisional biopsy was performed. The mass was well de-marcated from the adjacent soft tissue by a thin fibrous capsule. The cut surface showed a yellow, glistening lobular parenchyma with areas of blood-filled cystic spaces. Histologically, the pa-renchyma was composed of luteinized granulosa and theca cell layers, suggesting corpus luteum of the ovary (Fig. 2). There was no evidence of endometriosis. A review of the operation record of the laparoscopic surgery …