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    prior complex fluid left adnexa
    An_197843 posted:
    I have had my left ovary and tube removed about 20 yrs ago, I'm 52, good health and weight. no children. I had my 4th Ultrasound, Pelvic Trans-abdominal and Transvaginal test done and scheduled another. The results show 620.8 code, and notes for "Please evaluate left ovary and comment on prior complex fluid left adnexa" My Dr. said I have a small cyst, but he said yesterday he didn't feel anything during our routine PAP. can you give me some information on this.
    Jane Harrison Hohner, RN, RNP responded:
    Dear Anon: Without access to your medical records the following can only be my best GUESS. If your left ovary and tube were removed and now you are showing some type of complex cyst with fluid on the left you MAY have ovarian remnant syndrome. Here is a citation on this from the National Library of Medicine site:

    Gynecol Obstet Fertil. 2009 Jun;37(6):488-94.
    [Ovarian remnant syndrome: diagnostic difficulties and management>.
    [Article in French>
    Fat BC, Terzibachian JJ, Bertrand V, Leung F, de Lapparent T, Grisey A, Maillet R, Riethmuller D.

    Service de gynécologie-obstétrique, centre hospitalier de Belfort-Montbéliard, site de Belfort, 14, 90016 Belfort, France.

    The ovarian remnant syndrome is a rare condition after unilateral or bilateral oophorectomy, with or without a hysterectomy. This syndrome occurs when a fragment of ovarian tissue is left behind and becomes functional and cystic. The purpose of this study is to report the cases of patients treated surgically for an ovarian remnant syndrome during the last 10 years and to recall the diagnostic and therapeutic difficulties.

    A retrospective, observational study was carried out between 1997 and 2006. Seven patients were treated surgically for an ovarian remnant syndrome. Perioperative data analysis (history, surgical techniques, and postoperative follow-up) was carried out.

    The mean age of the patients was 46 years (36-55). The number of previous abdominal surgical procedures ranged from 2 to 5. The syndrome appeared after a mean period of 4 years and 4 months (range 5 months-12 years) after oophorectomy. Among the 7 patients, 3 had had a previous hysterectomy. Pelvic pain was found in all cases. Gonadotropin-releasing hormones agonists were used in 1 patient without success. Aspiration was performed in 2 cases before surgical treatment. Two patients underwent a laparotomy in the first place. Laparoscopy was performed in 5 cases and laparoconversion was necessary in 1 case. Intraoperative difficulties and anatomic variations were found in all cases. Ureteral catheters were placed in 2 cases. Radiotherapy was performed in 1 patient who had a recurrent ovarian remnant.

    The ovarian remnant syndrome is a rare complication. Surgery, either by laparoscopy or by laparotomy, is the recommended treatment. These operations are often difficult and associated with a high risk of complications. Histologically, remnant ovarian tissue associated with hemorragic corpus luteum cysts is the most common finding. The prevention of the ovarian remnant syndrome is based on rigorous surgical treatment during the oophorectomy so as not to leave behind ovarian tissue.

    Anon, one of the most common causes of ovarian remnant syndrome is adhesions from endometriosis. Adhesions (filmy bands of scar tissue) web together the contents of the abdomen making it difficult to separate structures so they can be removed easily. Adhesions can also arise from former pelvic infections ("PID"), other GYN surgeries, or even a ruptured appendix as a child.

    It sounds like your GYN is doing a thorough work up. PLEASE ask them for a more "for sure" answer as to what the ultrasound reported.

    pennydob replied to Jane Harrison Hohner, RN, RNP's response:
    I'm sorry, it was not my left ovary it was my right ovary that was taken out, so I still have my left and that is where the prior complex fluid left adnexa.
    Cleopatria replied to Jane Harrison Hohner, RN, RNP's response:
    Thank you a million, Jane, for this wonderful article! I am almost in tears after reading it. I had a total hyst. bil/oopherectomy when I was 28 yrs. old after having 5 surgeries for endometriosis. For years I have been suffering with ovarian remnant syndrome, esp. since my doctor gave me massive doses of Prednisone as part of my rx for NH Lymphoma. I have now developed multiple bowel obstructions and severe arthritis -- more prednisone. I just wanted to thank you for your very enlightening article. I am now 83 yrs. of age and can live with the problems. I am ever so grateful for finally learning that I can still have endometriosis. Hats off, to you, dear girl. May your life be blessed!
    From Lorene, retired RN
    Jane Harrison Hohner, RN, RNP replied to Cleopatria's response:
    Dear Cleopatria: Gosh, I don't know how you found this explanation of ovarian remnant syndrome, but I'm glad you found it useful....You brought up a very important point about endometriosis in the postmenopausal woman that deserves some more comment.

    It is very true that any adhesions from earlier, very active, endometriosis will remain. Yet most GYNs feel that, since estrogen is the "fuel" for endometriosis to flourish (and progesterone the "break" to endo growth), that after menopause endo implants tend to atrophy. If a woman with prior endo chooses to use hormone therapy after menopause for severe hot flashes, her endo may continue to grow. This can include small implants that remain even after very thorough surgical removal. So even if a woman has had a hysterectomy, if she has had prior endometriosis, she may want to ask her GYN about using progesterone if she takes estrogen for hot flashes.

    Cleopatria, you have been through a remarkable number of surgeries and health consequences, and your gratitude for a certain diagnosis is humbling. It would be so fantastic if there were some other, easier, way to confidently diagnose endometriois that surgery and biopsy.

    Cleopatria replied to Jane Harrison Hohner, RN, RNP's response:
    Thanks again, Jane, for your response. You are doing a tremendously valuable work by providing this site.

    Retired RN

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