The residual adnexa syndrome

The clinical profile of a group of 208 women who presented with residual adnexal disease subsequent to hysterectomy was studied retrospectively; 121 patients had the uterus removed vaginally and 87 per abdomen. The majority of the patients had the hysterectomy at less than 40 years of age, with a mean and median age of 33 years, and more than 60% presented with adnexal symptoms and signs within 5 years of hysterectomy. A detailed analysis of the symptoms and signs and pathology of the removed uterus in both groups was similar although as expected there was an associated finding of prolapse in a significant number of those treated by vaginal hysterectomy. There were significant delays both in the definitive diagnosis of subsequent residual adnexal disease and definitive treatment. The pathological changes in the removed residual adnexa were varied, but with a high incidence of inflammatory changes involving both the tube and ovary. This was particularly evident in those patients in whom the uterus had been removed by the vaginal route, suggesting that this may be related to the usual fixation or approximation of the conserved tube to the vaginal vault at the time of vaginal hysterectomy.