Laparoscopic Surgery of Massive Ovarian Edema: A Case Report and Literature Review

Massive ovarian edema (MOE) is a rare benign clinical entity that can be confused with neoplastic ovarian tumor. Usually, ovarian torsion develops secondary to an ovarian tumor, but at times, it might develop even in a normal ovary. Most MOE occurs because of intermittent torsion of the normal ovary and compromised venous or lymphatic drainage, which subsequently involve the arteries. The major symptoms of MOE are abdominal pain, due to torsion of the stem. Since it is not a neoplastic disease, a therapy that preserves fertility should be the principle of treatment. We present here, our case along with a literature review on the subject. A 9-year-old girl was admitted in our hospital with abdominal pain and was diagnosed with MOE based on ultrasonography and Magnetic Resonance Imaging findings. After the first onset, conservative therapy with analgesics was administered for about 7 months during repeat exacerbations. A second episode of severe abdominal pain occurred after 7 months. Although ovarian blood flow was preserved on imaging investigations, laparoscopic surgery was performed due to increasing pain. Untwisting and wedge resection of the ovary and ovarian fixation was performed. Clinical follow-up at 5 months using ultrasonography examination revealed no recurrence of the torsion. If the ovarian blood flow is maintained as in this case, conservative treatment is possible, but surgical therapy is considered if there is a worsening of symptoms such as pain or absence of ovarian blood flow. Laparoscopic surgery for untwisting the torsion is initially recommended. Wedge resection of the ovary should be considered. There are pros and cons for ovarian fixation, but it should be enforced in cases where there is a concern about revolving easily.