When Cysts Mislead: A Case Report of Ovarian Cyst Resembling Giant Ureterocele after Hysterectomy.

Abstract

Background: Women undergoing hysterectomy without oophorectomy face a risk of needing re-surgery for new adnexal conditions. Additionally, large ovarian cysts in posthysterectomy patients can complicate diagnoses, often mimicking conditions, like mesenteric cysts, massive ascites, or giant hydronephrosis.

Case presentation: A 54-year-old para four and live four (P4L4) post-hysterectomy woman presented to the gynecological outpatient department with complaints of lower abdominal and back pain lasting seven days, along with difficulty urinating and burning during micturition. Her initial outside imaging, including a CECT and CT-urogram, suggested a grade three or four ureterocele, with potential differentials, such as megaureter and vesicoureteric reflux. However, upon clinical examination and further evaluation using MRI, it was found to be a large left-sided ovarian cyst of 13.8x9.5x11.3 cm causing hydroureteronephrosis (left>right). Her intraoperative findings revealed a large predominantly, tense cystic lesion of size 13x12 cm, completely occupying the lower pelvis in the midline, and it was densely adherent to the bladder and omentum anteriorly, and to the bowel posteriorly and on sides. Subsequent histopathological examination confirmed it as a mucinous cystadenoma of the ovary.

Conclusion: Large ovarian masses in post-hysterectomy patients present significant diagnostic and management challenges as they can mimic a range of conditions. This underscores the need for a multidisciplinary approach to improve diagnostic accuracy and optimize patient outcomes.