Introduction and aims: Ovarian remnant syndrome (ORS) is a rare gynecological complication, most often induced by difficult salpingoophorectomy that leave residual ovarian tissue on the pelvic wall. Recurrent serous cystadenoma may arise from ORS. Our objective was to enhance the importance of diagnosis and surgical management in patients with ORS. Methods: We describe the case of a patient with continuous interventions before radical surgery for ORS. She had a right nephrectomy at age 43, a total abdominal hysterectomy at 45, and bilateral adnexectomy for serous cystadenoma at age 47. After thirteen years of continuous transvaginal aspirations for recurrent cystadenoma, and two laparotomies for cystectomies she was referred to our center. She presented with an abdomino-pelvic mass of 22cm, pain, and compression symptoms. Basic surgical principles were followed: high religation and resection of gonadal vessels; bilateral stripping and excision of the pelvic side wall peritoneum; wide excision of tissue surrounding the remnant ovary. Results and discussion: She needed partial bladder and sigma resection, and comprehensive ureterolysis for complete surgical resection, without significant postoperative complications. Histollogically, remnant ovarian tissue was associated with serous cystadenoma. After being heavily pretreated the modest risk of bowel, bladder or ureteral trauma caused definitive sidewall stripping and vaginal excision. Nearly two years later it occurred a low-rate growing cystic colonic perianastomosis recurrence of 3cm, which has reached 6 cm to date, and remains completely asymptomatic. Conclusions: Meticulous surgery is advised to assure the best outcome to patients. Even a benign non-threatening lesion such as ovarian serous cystadenoma may become a locorregional problem, with aggressive behavior similar to low-grade malignant lesions.
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