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

Background: Pelvic organ prolapse (POP) in postmenopausal women may coincide with adnexal masses, such as paraovarian or ovarian cysts, complicating diagnosis and surgical planning. Furthermore, incidental appendicitis discovered during pelvic surgery is exceedingly rare, posing additional intraoperative challenges. Case Presentation: We describe a 67-year-old postmenopausal woman with chronic constipation and pelvic discomfort. Imaging (ultrasound and CT) revealed right-sided paraovarian (~6 cm) and ovarian cysts, right hydrosalpinx, and stage II POP involving both anterior and posterior vaginal walls. During laparoscopic exploration, acute appendicitis was discovered unexpectedly. The patient underwent laparoscopic appendectomy, total vaginal hysterectomy, right salpingo-oophorectomy, anterior and posterior colporrhaphy, and levator ani reconstruction. She recovered uneventfully and at three-month follow-up her pelvic symptoms resolved. Conclusions: This unique case underscores the importance of detailed preoperative imaging, intraoperative vigilance, and a coordinated multidisciplinary surgical approach in managing complex pelvic pathology in postmenopausal women. INTRODUCTION Pelvic 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.