1. WANDERING OVARY DR. J.CHITRA M.D, DGO, D.NB ASST PROFESSOR KANYAKUMARI GOVT MEDICAL COLLEGE

2. Clinical history o 24 years old young unmarried girl o Acute abdominal pain for 4 days o Attained menarche 14 th year o Periods once in 2 months / 3 days o Painless, scanty periods

3. Previous history 1 year back, was treated for the same acute abdominal pain elsewhere. 1 year back, was treated for the same acute abdominal pain elsewhere. Diagnosed as bilateral multiloculated ovarian cysts Diagnosed as bilateral multiloculated ovarian cysts Advised surgery- she refused Advised surgery- she refused Treated conservatively Treated conservatively She was symptom free for one year She was symptom free for one year

4. Scan report Scan taken on 5.10.04 Scan taken on 5.10.04 Rt.Ovary 12x12cm Cystic, multilocular, thin walled Rt.Ovary 12x12cm Cystic, multilocular, thin walled Lt Ovary 11x12 cm, cystic Lt Ovary 11x12 cm, cystic

5. CLINICAL EXAMINATION O/E - P/A no mass palpable O/E - P/A no mass palpable P/R - Cystic, tender mass felt occupying the pouch of P/R - Cystic, tender mass felt occupying the pouch of Douglas Douglas Routine investigations normal Routine investigations normal Ultrasonagram Ultrasonagram right ovarian cyst –multi loculated 12 x 12 cm right ovarian cyst –multi loculated 12 x 12 cm Left ovary –not visualized Left ovary –not visualized Uterus normal Uterus normal

8. LAPAROSCOPY FINDINGS  Right Ovary  Twisted  Cystic, Multilocular  Variable in size  Thin walled

9. Procedure on Right ovarian cyst Untwisting of the ovarian cyst done Untwisting of the ovarian cyst done Cystectomy done Cystectomy done Remaining ovarian tissue left out Remaining ovarian tissue left out LEFT OVARY NOT SEEN AT ITS SITE

10. Amputated site of left ovary ATTACHED TO OMENTUMOVARY

11. WANDERING OVARY Normal looking ovary,3.5 cm x 3 cm x 2 cm in size, seen attached to omentum Normal looking ovary,3.5 cm x 3 cm x 2 cm in size, seen attached to omentum Feeding vessels are seen from omentum Feeding vessels are seen from omentum

12. Procedure on Right ovarian cyst Untwisting of the ovarian cyst done Untwisting of the ovarian cyst done Cystectomy done Cystectomy done Remaining ovarian tissue left out Remaining ovarian tissue left out LEFT OVARY NOT SEEN AT ITS SITE

13. HPE SIMPLE SEROUS CYST RIGHT OVARIAN CYST HPE SIMPLE SEROUS CYST RIGHT OVARIAN CYST AMPUTED OVARIAN BIOPSY CONFIRMED OVARIAN TISSUE – HPE AMPUTED OVARIAN BIOPSY CONFIRMED OVARIAN TISSUE – HPE

14. FOLLOW UP REGULAR MENSTRUATION STARTED AFTER THREE MONTHS AFTER ONE YEAR ULTRA SOUND REVEALED NORMAL UTERUS. RIGHT OVARY 4 x 3cms LEFT OVARY NOT SEEN NO OTHER CYSTIC MASS SEEN  PLAIN X-RAY – NO CALCIFICATION NOTED

18. THANK YOU