SURGICAL RESECTION OF BILATERAL POLYCYSTIC OVARIES CAUSING URETERAL OBSTRUCTION

Objectives: Background
Ovarian cysts in adolescents are typically managed conservatively given the low rate of malignancy and the cysts typically regress over time. We present a case of a 14 year-old female with large bilateral adnexal cysts causing ureteral obstruction which was successfully treated with surgical resection.

Case Description
The patient was a 14 year-old obese female with no previous past medical history who presented to the emergency room with generalized abdominal pain, nausea and vomiting for two days. Computed tomography (CT) of the abdomen and pelvis demonstrated large bilateral adnexal masses measuring 13.3 x 10.1 x 16.7 centimeters (cm) on the right and 18.1 x 10.5 x 15.8cm on the left, causing bilateral hydronephrosis and bladder compression. Cancer antigen 125 (CA 125) was mildly elevated at 43.9, but remaining tumor markers and laboratory results including uric acid, lactate dehydrogenase, alpha-fetoprotein (AFP), quantitative beta human chorionic gonadotropin (hCG), and inhibin A and B were all within normal limits. Due to symptoms of pain and compressive symptoms, the decision was made to take the patient to the operating room (OR) for exploratory laparotomy with bilateral cystectomies. Intra-operatively, multiple, large bilateral ovarian cysts were seen with simple, clear fluid. These were individually enucleated until only sub centimeter cysts and ovarian tissue remained. Bilateral fallopian tubes and ovaries were examined and found to be healthy. The patient’s post-operative course was uncomplicated and abdominal pain had resolved at follow-up appointment. Final pathology returned as bilateral cystadenomas without evidence of malignancy. Given these findings and pathology results, it was determined that this was most consistent with a benign process, likely significant polycystic ovary syndrome (PCOS).

Discussion:
This case highlights the consideration for surgical management of polycystic ovaries to minimize compressive symptoms. We present a case of successful bilateral ovarian cystectomies resulting in the resolution of abdominal pain and ureteral obstruction.

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