Adnexa, ovaries, and fallopian tubes

The ovaries are the female gonads in the reproductive system and pivotal in steroid production and maintenance of long-term health, beyond reproductive function (Figs. 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, and 2.8) [1]. They are bilateral structures that measure 2-3 cm in length in a reproductive age woman and are in the pelvic cavity. The broad ligament is the double of the peritoneum that covers the pelvic organs and can be divided into three regions based on vicinity to reproductive organs: the mesosalpinx (fallopian tube), mesovarium (ovary), and mesometrium (uterus) (Figs. 2.4, 2.5, 2.6, and 2.7). The suspensory ligament of the ovary or the infundibulopelvic ligament (IP) is an extension of mesovarium that contains the ovarian blood and lymph vessels and anchors the ovary to the pelvic sidewall (Fig. 2.3). The utero-ovarian ligament attaches the ovary to the uterus (Figs. 2.1, 2.2, and 2.3) [2, 3]. The primary blood supply to the ovary is the ovarian artery although there is some anastomosis with branches of the uterine artery. Venous pampiniform plexus drains into the ovarian veins. Right ovarian vein drains into the inferior vena cava and left ovarian vein drains into the left renal vein. Lymphatics drain alongside the ovarian vessels either to para-aortic nodes, or follow para-uterine vessels to iliac nodes, or alternative routes include inguinal nodes via round ligament [2, 3].