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Congenital unilateral absence of an ovary medicolegal case

Posted by Dr Mike O'Connor on 28 January 2014

Recently I was asked to provide an expert opinion on the causation of a missing ovary discovered at  a third laparoscopy. It was alleged by another expert witness that this must have been surgically removed at one of the 2 previous laparoscopies, both of which were brief procedures. The witness stated that in his experience congenital absence of one ovary had never occurred.

In fact there have been a number of case reports of just such congenital absence of only one ovary: in 1978 Sivisena reported absence of a left tube and ovary and referred to 3 similar previous case reports; in 1986 Sivanesaratnam reported 2 cases in Malaysia; in 1992 Eustace reported 2 cases in England and in 2009 Ackuyu reported 4 cases in Turkey. Subsequently Pabuccu, also from Turkey, reported another case in a 21 year old girl with 3 years of primary infertility. That 2011 paper cited another 7 cases in the world literature: 3 of those had associated uterine and renal developmental anomalies. Sivanesaratnam estimated that the incidence of unilateral absence of an ovary was lower than 1:11,000 women.

Eustace (1992) postulated that such unilateral ovarian absence could also arise from asymptomatic torsion of an ovary either in utero or during postnatal life. Pabuccu favoured a theory of causation involving a vascular accident.

Last year (2013) Liu et al reported one case and analysed a further 38 cases in the world literature!

1. Sirisena LA (1978) 54 Postgraduate Medical Journal 423-424
2. Sivanesaratnam V (1986)  22 European Journal of Obstetrics & Gynecology & Reproductive Biology 103-105
3. Eustace DL (1992) 46 European J Obstetrics & Gynecology and Reproductive Biology 157-159
4. Ackuyu et al (2009) 91(3) Fertil Steril 936:e5-e8.
5. Dueck et al (2001) 17  Pediatric Surgery International 228-229
6. Pabuccu et al (2011) 96 Fertil Steril e55-e57
7. Liu Q et al (2013) 288 Archives of Gynecology and Obstetrics 555-561.

Author:Dr Mike O'Connor
About: Dr Mike O'Connor is an obstetrician and gynaecologist based at Kogarah in Sydney's southern suburbs. Dr O'Connor is the current Chairman of the Medical Advisory Committee at St George Private hospital. He also has a Masters in Health Law and is a Fellow of the Australasian College of Legal Medicine and acts as an expert witness in medico legal issues.

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