Ovarian Remnant Syndrome

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As residual ovary syndrome (Eierstockrest- syndrome ) refers to a condition that is a result of remaining remnants of the ovary after ovary removal ( oophorectomy arises). It can arise either from incomplete removal of the ovaries (better known as residual ovary syndrome ) or from ectopic ovarian tissue that has remained in the abdominal cavity . The incidence in neutered bitches is around 1.8%.

clinic

In women, Ovarian Remnant Syndrome manifests itself in permanent or regularly recurring abdominal pain. Urinary tract problems, weakness, fever, nausea, vaginal bleeding, and painful bowel movements may also occur.

In bitches and cats despite castration occurs again estrus or heat cycle as in intact animals. In females often develop Scheinträchtigkeiten or stump pyometra . In addition, bitches can develop a granulosa cell tumor from residual ovaries with symptoms of heat, the formation of the mammary glands , skin problems, bone marrow depression and endometrial hyperplasia . Overall, the syndrome is more common in cats than in dogs, and it is almost entirely a surgical error (incomplete ovarian removal), ectopic tissue is very rare.

Diagnosis

Vaginal cytological picture of a bitch with Ovarian-Remnant-Syndrome: Typical cell picture of later proestrus (intermediate cells, superficial cells and erythrocytes)

Clinically, an ovarian remnant syndrome can hardly be clarified. However, the occurrence of a false pregnancy is a strong indicator, as this is exclusively progesterone- dependent. Ovarian remnant tissue can be visualized by sonography or magnetic resonance imaging , if necessary after administration of clomiphene 10 days before the examination. However, ultrasound imaging can be difficult or even impossible, especially when it comes to dispersed ovarian tissue.

Laboratory diagnostics are particularly high levels of estrogens or progesterone in line with the normal sexual cycle . A basal progesterone level can also occur if there is iron stick tissue when a bitch is in anestrus. The determination of FSH and LH is also possible, since the levels of both hormones are increased in completely castrated bitches due to the lack of negative feedback from the ovarian hormones. To exclude the physiological LH peak shortly before ovulation, a second LH determination is necessary after a few days. Finally, the detection of anti-Müllerian hormone by ELISA can be used, since this hormone is only produced in the ovary.

The measurement of estrogens is not practicable in veterinary medicine, but its effect can be demonstrated using vaginal cytology . If this is not clear, it should be repeated after an ovarian stimulation test . Alternatively, the progesterone level can be measured 5 to 7 days after the suspected rupture of the follicle . If necessary, the follicle rupture can also be triggered with hCG or GnRH . Progesterone levels above 2 ng / ml (6.4 nmol / l) are evidence of the presence of corpuscles and thus hormonally active ovarian tissue.

therapy

Ovarrest (below the thumb), surgical site

Therapy consists in the surgical removal of the remaining tissue.

In dogs and cats, the operation should be carried out during the hormonally active phase (heat or metestrus ), as the ovarian tissue is easier to find because of the ovarian follicles or corpuscles.

literature

  • RL Ball et al .: Ovarian remnant syndrome in dogs and cats: 21 cases (2000-2007) . In: JAVMA Volume 236, 2010, pp. 548-553.
  • Manfred Kaufmann , Serban-Dan Costa , Anton Scharl (Ed.): The gynecology. 2nd completely revised and updated edition. Springer Medicine, Heidelberg 2006, ISBN 3-540-25664-4 , p. 306.
  • Richard P. Billingham (Ed.): Reoperative Pelvic Surgery. Springer Science + Business Media, New York NY 2009, ISBN 978-0-387-89998-5 , pp. 46-47.
  • Margaret V. Root Kustritz: The dog breeder's guide to successful breeding and health management. Saunders Elsevier, St. Louis MO 2006, ISBN 1-416-03139-1 , p. 46.
  • Cheri A. Johnson: Ovarian Remnant Syndrome. In: Richard W. Nelson, C. Guillermo Couto (Eds.): Small Animal Internal Medicine. 3rd edition. Mosby, St. Louis MO 2003, ISBN 0-323-01724-X , pp. 867-868.
  • S. Goericke-Pesch et al .: Incidence and clinical symptoms of Ovarian Remnant Syndrome and ovarian tumors in the bitch. In: Kleintierpraxis 58 (2013), p. 37.
  • Axel Wehrend: Key symptoms of gynecology and obstetrics in dogs. Enke Stuttgart 2010, ISBN 978-3-83-041076-8 , pp. 163-164.