Surgical Management of Ovarian Residual and Remnant
After hysterectomy without salpingo-oophorectomy (bilateral or unilateral), the residual adnexa not uncommonly becomes symptomatic in the form of chronic abdominal pain. The reasons for this pain are myriad but frequently involve adhesions between the residual adnexa attached to the intestines, the bladder, or the peritoneum. The adnexa itself may be completely invested in fibrous tissue and may be densely bound to the pelvic wall in the region of the obturator fossa. Surgery to remove the residual requires careful, gentle, sharp dissection and contemporaneous, compulsive hemostasis. Obviously, precise knowledge of pelvic anatomy is requisite to a successful, noncomplicated outcome. Figure 27–1 illustrates the above points in that distinguishing between hydrosalpinx and intestine may be challenging (Fig. 27–2).
The remnant ovary represents a portion of an ovary that ostensibly had been completely removed at the time of the previous oophorectomy. Obviously, the premise was incorrect because the retained piece of ovarian tissue provides testimony to the fact that the excision of the ovary was not complete.
