Incidental diagnosis of an accessory ovary during cesarean section: a case report and literature review

Introduction and importance: An accessory ovary refers to the presence of more than two ovaries, with a third ovary located near a eutopic ovary and directly connected to the normal ovary. Due to its rarity, limited evidence exists regarding optimal management, particularly when it is diagnosed during pregnancy. Case presentation: A 31-year-old multigravida woman underwent a cesarean section at term for obstetric indications. The pregnancy had been uneventful, and no adnexal abnormality had been identified during the antenatal period. During intraoperative exploration, two adjacent ovaries with visible follicles were identified in the right adnexa. The ovaries appeared macroscopically normal, with no evidence of torsion, cyst formation, or malignancy. The patient had no symptoms suggestive of adnexal disease. Conservative management was chosen, and the postoperative course was uneventful. Clinical discussion: Accessory ovaries are uncommon congenital anomalies that may be associated with genitourinary and Müllerian abnormalities. Preoperative diagnosis is difficult because clinical manifestations are often absent and imaging findings may be inconclusive. In asymptomatic patients with a normal intraoperative appearance, conservative management may be appropriate. However, awareness of this anomaly is important because the accessory ovary may undergo the same pathological processes as the normal ovary, including neoplastic changes. Conclusion: This case illustrates the incidental diagnosis of an accessory ovary during a cesarean section in an asymptomatic pregnant woman. Recognition of this rare anatomical variation is important to avoid misdiagnosis and unnecessary surgical intervention. Careful assessment for associated congenital anomalies, along with appropriate follow-up, should be considered when resources permit.