{"paper_id":"64fc60c0-52fd-4782-85b4-2bfc90a0477e","body_text":"A Rare Case of Pelvic Organ Prolapse with Adnexal Masses and Incidentally Diagnosed Appendicitis in a 67 Year Old Postmenopausal Woman: A Multidisciplinary Case Report\nAuthors/Creators\nDescription\nBackground: Pelvic organ prolapse (POP) in postmenopausal women may coincide with adnexal masses, such as\nparaovarian or ovarian cysts, complicating diagnosis and surgical planning. Furthermore, incidental appendicitis\ndiscovered during pelvic surgery is exceedingly rare, posing additional intraoperative challenges. Case\nPresentation: We describe a 67-year-old postmenopausal woman with chronic constipation and pelvic discomfort.\nImaging (ultrasound and CT) revealed right-sided paraovarian (~6 cm) and ovarian cysts, right hydrosalpinx, and\nstage II POP involving both anterior and posterior vaginal walls. During laparoscopic exploration, acute appendicitis\nwas discovered unexpectedly. The patient underwent laparoscopic appendectomy, total vaginal hysterectomy,\nright salpingo-oophorectomy, anterior and posterior colporrhaphy, and levator ani reconstruction. She recovered\nuneventfully and at three-month follow-up her pelvic symptoms resolved. Conclusions: This unique case\nunderscores the importance of detailed preoperative imaging, intraoperative vigilance, and a coordinated\nmultidisciplinary surgical approach in managing complex pelvic pathology in postmenopausal women.\nINTRODUCTION\nPelvic organ prolapse (POP) is a frequent condition in women, particularly in the postmenopausal population, due to loss of connective tissue elasticity, hormonal changes, and increased lifetime exposure to intra-abdominal stress [1,2]. While mild prolapse is common, advanced prolapse (stage III– IV) is less frequently observed in women without prior pelvic surgery or childbirth-related trauma [3]. Concurrently, adnexal masses such as paraovarian cysts and ovarian cysts may occur in postmenopausal women. Paraovarian cysts, arising from mesosalpinx or paratubal tissue, account for a minority of adnexal masses (10–20%) and are often benign and asymptomatic [4–6]. Hydrosalpinx in older women may reflect prior inflammation or surgery [7]. Incidental appendicitis discovered during gynecologic surgery is exceptionally rare but has been reported in isolated cases [8–10]. Its unexpected presence adds complexity to surgical decision-making, especially in elderly patients with comorbidities. We report a rare case of a 67-year-old woman with advanced POP, coexisting adnexal cystic masses, and incidental acute appendicitis detected during laparoscopic surgery. We discuss the diagnostic evaluation, surgical strategy, and postoperative outcome, emphasizing the importance of a multidisciplinary approach.\nFiles\nCase report POP and Appendictomy .pdf\nFiles\n(253.9 kB)\n| Name | Size | Download all |\n|---|---|---|\n|\nmd5:5f278e8bff5d14378eadddfa3c025a36\n|\n253.9 kB | Preview Download |\nAdditional details\nReferences\n- 1. Smith, A. J., Jones, B. R. Epidemiology of pelvic organ prolapse in postmenopausal women. Maturitas 2018, 115, 46–52.\n- 2. Barber, M. D.; Maher, C. Epidemiology and outcome assessment of pelvic organ prolapse. Int. Urogynecol. J. 2013, 24, 1783–1790.\n- 3. Olsen, A. L.; Smith, V. J.; Bergstrom, J. O.; Colling, J. C.; Clark, A. L. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet. Gynecol. 1997, 89, 501–506.\n- 4. Savelli, L.; Ghi, T.; De Iaco, P.; Ceccarini, M.; Venturoli, S.; Cacciatore, B. Paraovarian/paratubal cysts: correlation of transvaginal sonographic and pathological findings. Hum. Reprod. 2006, 21, 3428– 3433.\n- 5. Kiseli, M.; Caglar, G. S.; Cengiz, S. D.; Karadag, D.; Yilmaz, M. Clinical presentation and complications of paraovarian cysts: a literature review. J. Obstet. Gynaecol. Res. 2012, 38, 849–856.\n- 6. Jain, K. A. Sonographic spectrum of paraovarian and paratubal cysts. Ultrasound Q. 2010, 26, 57–62.\n- 7. Bae, J. H.; Lee, H. J.; Choi, S. Hydrosalpinx in postmenopausal women: clinical significance and management. Obstet. Gynecol. Sci. 2019, 62, 431– 438.\n- 9. Green, M.; Patel, R.; Gupta, N. Acute appendicitis discovered during pelvic reconstructive surgery: case series. Gynecol. Surg. 2016, 13, 327– 333.\n- 10. Lee, C. Y.; Tseng, C. L.; Lin, Y. Unexpected appendiceal pathology during pelvic surgery in elderly women. Clin. Interv. Aging 2017, 12, 1057–1062","source_license":"CC0","license_restricted":false}