A 63-year-old postmenopausal woman comes to the office due to right-sided lower abdominal pain for the last 5 months. The patient has had no changes in bowel or bladder habits, no increase in abdominal girth or bloating, and no early satiety. Physical examination shows a soft abdomen with slight tenderness to palpation over the right lower quadrant. On pelvic examination, the uterus is small and the right adnexa is enlarged. Transvaginal ultrasound shows a normal uterus; a unilateral, 3.5-cm, complex ovarian mass with cystic and solid components; and no free fluid in the pelvis. Surgery is planned to remove the right ovary, including the mass. To avoid excessive bleeding, which of the following structures should be ligated during the oophorectomy?

Question

A 63-year-old postmenopausal woman comes to the office due to right-sided lower abdominal pain for the last 5 months.  The patient has had no changes in bowel or bladder habits, no increase in abdominal girth or bloating, and no early satiety.  Physical examination shows a soft abdomen with slight tenderness to palpation over the right lower quadrant.  On pelvic examination, the uterus is small and the right adnexa is enlarged.  Transvaginal ultrasound shows a normal uterus; a unilateral, 3.5-cm, complex ovarian mass with cystic and solid components; and no free fluid in the pelvis.  Surgery is planned to remove the right ovary, including the mass.  To avoid excessive bleeding, which of the following structures should be ligated during the oophorectomy?

Quizplus · Accepted Answer

11ec160b_3575_1766_9249_07e9bab0dde9_MD0001_00 The broad ligament, a sheet of peritoneum extending from the uterus and upper cervix to the pelvic sidewall, is divided into 3 parts: The ovaries, located posterolaterally to the uterus, are suspended by the mesovarium superiorly, the uteroovarian ligament medially, and the suspensory ligament of the ovary laterally. The suspensory ligament of the ovary, also known as the infundibulopelvic ligament, is a fold of peritoneum that attaches the ovary to the pelvic sidewall and contains the ovarian artery (the ovary's main blood supply), ovarian vein, lymphatics, and nerves. Therefore, the suspensory ligament of the ovary must be ligated during an oophorectomy to prevent heavy ovarian bleeding. (Choice A) The mesosalpinx does not contain the major vascular supply to the ovary. During a tubal ligation, an opening is made within the mesosalpinx below the isthmic portion of the fallopian tube to ligate a segment of the tube. (Choice B) The round ligament of the uterus originates from the uterus (anteroinferior to the fallopian tube) and travels through the inguinal canal to attach to the labia majora. It contains the artery of Sampson, which is rarely a source of major bleeding during pelvic surgery. (Choice D) The transverse cervical ligament, also known as the cardinal ligament, extends from the cervix and lateral fornix of the vagina to the pelvic sidewall. The uterine artery courses within it, necessitating division and ligation of this ligament during a hysterectomy. (Choice E) The uteroovarian ligament courses in the broad ligament and connects the ovary to the uterus below the fallopian tubes. It contains no named vessels. Educational objective: The suspensory ligament of the ovary (ie, infundibulopelvic ligament) contains the ovarian artery, ovarian vein, lymphatics, and nerves. The ovarian artery is the major blood supply to the ovary. Therefore, the suspensory ligament of the ovary must be ligated during an oophorectomy to prevent heavy bleeding.

A 63-Year-Old Postmenopausal Woman Comes to the Office Due to Right-Sided