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Total Hysterectomy
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hbutterfly28 posted:
2 yrs ago I had a hysterectomy due to fibroiod tumors on my uterus. The sugery was done abdominally. My tubes, cervix, uterus and one ovary was taken. On the 3rd day, the day I was suppose to get to go home I was back in surgery because the ovary that the doctor left had been nicked and I had been bleeding for 2 days with 4 pints of blood in my abdomen. So going back in to stop the bleeding the doctor took the ovary that was originally left. About six months ago I had to have an appendectomy. After my appendectomy I was having a lot of stomach pain. Investing my abdominal pain the ultrasound showed a mass in my left pelvic area. I was told this was probably a hemotama from the appendectomy and not to worry it was dissolve. After 4 months the last month I was having terrible back pain and hurting in my lower left pelvic area but mainly my back hurt. While in the ER the doctor did a MRI on my back and said my back looked great but the MRI picked up the mass in my left pelvic area which had grown since the last scan I had done back when it was thought to be a hemotoma. I was back in surgery the next day and was told my ovaries and tubes had regenerated and thats why I was having the pain. It has been 3 months since my surgery and I'm hurting in my back and lower left pelvic area like I orginally was. Can you tubes and ovaries regenerate? Why could I be hurting the same way again? I'm just feeling so overwhelmed and confused. I'm only 34 and this has been alot. I couldn't have done all this without God and the love and support of my husband and kids. Confused about hurting again, and fighting anxiety about it.
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Anon_6061 responded:
How awful! I've read that the ovary can regenerate if a small piece of it is left. But it seems very odd that both ovaries and tubes could have regenerated if they were, in fact, removed. (I'm wondering if the gynecologist surgeon told you he removed them when in fact he didn't maybe mixing you up with another patient?)

Did you have any "menopausal" symptoms after the original surgery (hysterectomy) or did you start HRT shortly after? Women your age and even older typically feel the effects of ovary removal fairly quickly after surgery as ovarian hormones have many essential functions even after menopause. I didn't have hot flashes right away but sleep issues kicked in almost immediately.

Did you have the same pain before your appendectomy? What workups were done to indicate your appendix was the culprit? Many appendectomies are done without appropriate workups and the appendix wasn't the problem at all. Adhesions (scar tissue) develop after any type of surgery and these can cause pain so it's possible those are the source of your pain. Were your ovaries and tubes removed with the last surgery under the premise that removing them would resolve the pain?

It would be a good idea to get all your medical records and pay particular attention to your imaging (MRI) and surgical reports. In my opinion, I'd be looking for new doctors (ones affiliated with a different hospital) although doctors can be hesitant to "clean up" others' messes.
 
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Jane Harrison Hohner, RN, RNP responded:
Dear hbutterfly: Anon_6061 has given you some good information. I would like to add a couple of observations, too.

Yes, there is something called ovarian remnant syndrome. Here is a citation about this from the National Library of Medicine site:

Gynecol Obstet Fertil. 2009 Jun;37(6):488-94. doi: 10.1016/j.gyobfe.2009.03.027. Epub 2009 May 19.
[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.
Source

Service de gyn?cologie-obst?trique, centre hospitalier de Belfort-Montb?liard, site de Belfort, 14, 90016 Belfort, France. bchungfat@yahoo.fr
Abstract
OBJECTIVES:

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.
PATIENTS AND METHODS:

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.
RESULTS:

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.
DISCUSSION AND CONCLUSION:

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.

As you can note hbutterfly, neither ovaries nor tubes actually regenerate. But a tiny fragment of residual ovary, under the influence of the stimulating hormones from the pituitary, can grow cysts (some of them full of blood--"hemorrhagic cysts"). Some risk factors include: scar tissue from prior surgeries or infections, and endometriosis.

In terms of the continued pain, it is hard to know if the left sided mass is the sole culprit. There can be many reasons for left sided pain including entrapment of a nerve. I concur with Anon_6061's suggestion that you may want to seek a second opinion. Be sure they can get copies of your surgical reports and all imagining studies.

We are grieved that you are having to go through all of this at such a young age. I sincerely hope that you can regain your quality of life.

In Support,
Jane
 
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hbutterfly28 responded:
Thank you for you comment. After my hysterectomy and having to have to go back into surgery the next couple of days due to bleeding I did change doctors. I was told by the first doctor everything was removed so the doctor I have now, the one that done my surgery in October said looking back at the doctors notes that doctor did remove everything. My current doctor also made the comment she really didn't know what the mass was and said to her it seem to look like where the ovary and tube regenerated. In saying that she said she just took everything out that didn't look right. I am taking hormone replacement and have been doing that since my first surgery. I have had a few spells of hot flashes but that was at the beginning and I have had to deal with vaginal dryness but the estrogen cream has helped with that. I went to an Urgent Care center in my town and they sent me to have an ultrasound which did not see anything so I with continueing to have pain I went to see my current gynocologist and she informed yesterday that we would need to have a CT scan done. I have been having headaches these last few days. I hope the CT scan can tell us something and I hope and pray that it is nothing serious and that I won't be back in for surgery again. Praying faithfully for a good report.


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