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Saxena AK, Mutanen A, Gorter R, Conforti A, Bagolan P, De Coppi P, Soyer T. European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts. Eur J Pediatr Surg 2024; 34:215-221. [PMID: 37557903 DOI: 10.1055/s-0043-1771211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). METHODS The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. RESULTS There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. CONCLUSION A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.
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Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Annika Mutanen
- Department of Pediatric Surgery, University of Helsinki Children's Hospital, Helsinki, Finland
| | - Ramon Gorter
- Department of Pediatric Surgery, Emma Children's Hospital UMC, Amsterdam, the Netherlands
| | - Andrea Conforti
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesu' Children's Hospital, Rome, Italy
| | - Paolo De Coppi
- Department of Paediatric Surgery, UCL Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
- Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
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Gynecological Problems in Newborns and Infants. J Clin Med 2021; 10:jcm10051071. [PMID: 33806632 PMCID: PMC7961508 DOI: 10.3390/jcm10051071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Pediatric-adolescent or developmental gynecology has been separated from general gynecology because of the unique issues that affect the development and anatomy of growing girls and young women. It deals with patients from the neonatal period until maturity. There are not many gynecological problems that can be diagnosed in newborns; however, some are typical of the neonatal period. This paper aims to discuss the most frequent gynecological issues in the neonatal period.
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Chiarenza SF, Conighi ML, Conforti A, Bleve C, Esposito C, Escolino M, Beretta F, Cheli M, Di Benedetto V, Scuderi MG, Casadio G, Marzaro M, Gambino M, Pini Prato A, Molinaro F, Gerocarni Nappo S, Caione P. Guidelines of the Italian Society of Videosurgery in Infancy (SIVI) for the minimally invasive treatment of fetal and neonatal ovarian cysts. LA PEDIATRIA MEDICA E CHIRURGICA 2020; 42. [PMID: 33140631 DOI: 10.4081/pmc.2020.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
In the last three decades, fetal ovarian cysts were diagnosed more frequently, due to technological improvement and the increasing use of prenatal screening ultrasound. Nonetheless, treatment uncertainties are still present, either prenatally or postnatally. Recently, significant innovations on diagnosis and treatment have been proposed and a more conservative, minimally invasive approach may be offered to the Pediatrician or the Surgeon who face with this condition during prenatal or neonatal age. (...).
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Affiliation(s)
- Salvatore Fabio Chiarenza
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Maria Luisa Conighi
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Andrea Conforti
- Congenital Esophageal Disorders Unit, Neonatal Surgery Unit, Bambino Gesù Children's Research Hospital, Rome.
| | - Cosimo Bleve
- Pediatric Surgery and Urologic Unit, Regional Center of Minimally Invasive Surgery and Urology, S. Bortolo Hospital, Vicenza.
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University, Naples.
| | | | | | - Maurizio Cheli
- Pediatric Surgery Department Papa Giovanni XXIII Hospital, Bergamo.
| | | | | | | | - Maurizio Marzaro
- Pediatric Surgery Unit, Local Health Unit 2, Treviso Hospital, Treviso.
| | - Marco Gambino
- Pediatric Surgery Unit, Annunziata Civil Hospital, Cosenza.
| | - Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria.
| | - Francesco Molinaro
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena.
| | | | - Paolo Caione
- Pediatric Surgery and Urologic Unit, Pediatric Hospital Bambino Gesù, Rome.
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Rialon KL, Akinkuotu A, Fahy AS, Shelmerdine S, Traubici J, Chiu P. Management of ovarian lesions diagnosed during infancy. J Pediatr Surg 2019; 54:955-958. [PMID: 30795909 DOI: 10.1016/j.jpedsurg.2019.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior studies of infant ovarian cysts have recommended intervention for those larger than 4 cm. We reviewed the natural history and features of those managed operatively versus nonoperatively. METHODS A retrospective study was performed of ovarian lesions in children <1 year-old from 2000 to 2014. RESULTS Forty patients were identified. Twenty-eight (70%) underwent operative management, while 12 (30%) were managed conservatively, including one undergoing aspiration. The mean age at surgery was 125 days. All but one patient (96%) had evidence of antenatal torsion intraoperatively or on final pathology. All resected lesions were benign. Ultrasound findings more common in those undergoing surgery included intracystic debris (p < 0.001), fluid-fluid or fluid-debris levels (p = 0.002), absence of Doppler flow (p = 0.014), solid components (p = 0.04), and calcifications (p = 0.001). Cysts managed nonoperatively had an average diameter of 2.5 cm, compared to 5.1 cm in the operative group (p < 0.001). Three of the lesions managed nonoperatively had a diameter greater than 3.5 cm (mean 5.1 cm) and were followed for an average of 153 days until resolution. CONCLUSIONS The majority of infant ovarian lesions were excised, although none were malignant. Aspiration or observation of larger cysts was feasible and safe. Ovarian cysts in this age group should be considered for nonoperative management and closely followed. LEVEL OF EVIDENCE IIC.
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Affiliation(s)
- Kristy L Rialon
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adesola Akinkuotu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aodhnait S Fahy
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Susan Shelmerdine
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Traubici
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Priscilla Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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5
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Diguisto C, Winer N, Benoist G, Laurichesse-Delmas H, Potin J, Binet A, Lardy H, Morel B, Perrotin F. In-utero aspiration vs expectant management of anechoic fetal ovarian cysts: open randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:159-164. [PMID: 29205608 DOI: 10.1002/uog.18973] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of in-utero aspiration (IUA) of anechoic fetal ovarian cysts. METHODS This multicenter, prospective, randomized open trial in two parallel groups included women from nine outpatient fetal medicine departments with singleton pregnancy ≥ 28 weeks of gestation and a female fetus with an ultrasound-diagnosed simple ovarian cyst, defined as a single fully anechoic cystic structure measuring ≥ 30 mm. They were allocated randomly to IUA under ultrasound guidance or expectant management. All procedures were performed by trained senior obstetricians. Primary outcome was need for neonatal intervention, by laparoscopy, laparotomy or transabdominal aspiration. Secondary outcomes were in-utero involution of the cyst and oophorectomy at birth. Analyses were conducted according to the intention-to-treat principle. RESULTS Of 61 participants, 34 were allocated to IUA and 27 to expectant management. Three IUA procedures (9%) could not be performed (one due to fetal position and two due to aspirations being dry). The remaining 31 IUA procedures were uneventful. The incidence of neonatal intervention did not differ significantly between the IUA and the expectant management groups (20.6% vs 37.0%; relative risk (RR), 0.55; 95% CI, 0.24-1.27). Nonetheless, IUA was associated with increased incidence of in-utero involution of the cyst (47.1% vs 18.5%; RR, 2.54; 95% CI, 1.07-6.05) and reduced rate of oophorectomy (3.0% vs 22.0%; RR, 0.13; 95% CI, 0.02-1.03) compared with expectant management. CONCLUSION IUA of anechoic fetal ovarian cysts, compared with expectant management, was not associated with a reduction in overall neonatal interventions but was associated with a reduced oophorectomy rate. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Diguisto
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France
- Université François-Rabelais de Tours, Tours, France
| | - N Winer
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Nantes, CIC Mère-Enfant, Nantes, France
| | - G Benoist
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Caen, Caen, France
| | - H Laurichesse-Delmas
- CHU Clermont-Ferrand, Department of Obstetrics, Gynecology and Fetal Medicine, Estaing Hospital, Clermont-Ferrand, France
| | - J Potin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France
- Université François-Rabelais de Tours, Tours, France
| | - A Binet
- Université François-Rabelais de Tours, Tours, France
- Pediatric Surgery Department, University Hospital of Tours, Tours, France
| | - H Lardy
- Université François-Rabelais de Tours, Tours, France
- Pediatric Surgery Department, University Hospital of Tours, Tours, France
| | - B Morel
- Université François-Rabelais de Tours, Tours, France
- Pediatric Radiology Department, University Hospital of Tours, Tours, France
| | - F Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, Tours, France
- Université François-Rabelais de Tours, Tours, France
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Sintim-Damoa A, Majmudar AS, Cohen HL, Parvey LS. Pediatric Ovarian Torsion: Spectrum of Imaging Findings. Radiographics 2017; 37:1892-1908. [DOI: 10.1148/rg.2017170026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Akosua Sintim-Damoa
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Anand Shyamcharan Majmudar
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Harris L. Cohen
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
| | - Louis Swig Parvey
- From the Department of Radiology, LeBonheur Children’s Hospital, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103
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Llorens Salvador R, Sangüesa Nebot C, Pacheco Usmayo A, Picó Aliaga S, Garcés Iñigo E. Neonatal ovarian cysts: Ultrasound assessment and differential diagnosis. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Neonatal ovarian cysts: ultrasound assessment and differential diagnosis. RADIOLOGIA 2017; 59:31-39. [PMID: 28024877 DOI: 10.1016/j.rx.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 12/26/2022]
Abstract
Ovarian cysts are the most common abdominal cysts in female fetuses and newborn girls. Ultrasonography is the imaging technique of choice for diagnosing ovarian cysts because it makes it possible to differentiate them from other cystic lesions. Although most neonatal ovarian cysts regress in the first few months after birth, complications can occur during gestation or after birth. The manifestations of ovarian cysts on ultrasonography will depend on the complications. The management is controversial, although the current trend favors watchful waiting. We describe the different presentations of neonatal ovarian cysts with their complications and their patterns of findings on ultrasonography. We also discuss the differential diagnosis with other cystic abdominal lesions, and finally we discuss the therapeutic management of neonatal ovarian cysts.
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9
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Ovarian Cyst Aspiration in the Neonate: Minimally Invasive Surgery. J Pediatr Adolesc Gynecol 2015; 28:348-53. [PMID: 26148782 DOI: 10.1016/j.jpag.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/04/2014] [Accepted: 10/07/2014] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To review our experience with laparoscopic aspirations and minimally invasive surgeries for neonatal ovarian cysts and report the outcome of their follow-up. DESIGN Twenty-one neonates diagnosed as having ovarian cysts were retrospectively reviewed at our hospital from 2006 through 2013. RESULTS Of 21 neonates, 8 showed simple cysts and 13 showed complex cysts in their ultrasound scan. Laparoscopic aspiration was performed for all neonates with simple cysts. Torsion was found in 7 of 13 neonates with complex cysts. Three neonates underwent detorsion, while 2 neonates underwent oophorectomy. Two neonates already showed autoligation, showing a cystic mass, which was removed. The remaining 6 neonates with a complex cyst underwent only aspiration because no torsion was found. Of 14 neonates who underwent only aspiration, 11 showed no cyst, while 3 neonates, having a cyst with a size of less than 2 cm, underwent follow-up. Of 3 neonates who underwent detorsion, 1 showed an ovary without cyst, while 2 showed neither cyst nor ovary. CONCLUSION Laparoscopically, neonatal ovarian cysts may be diagnosed and aspirated simultaneously, simply, and safely.
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10
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Aamir M, Punia H, Dalal P, Sharma D. Conservative management of a large neonatal ovarian cyst: a case report. J Clin Diagn Res 2015; 9:SD04-5. [PMID: 26023615 DOI: 10.7860/jcdr/2015/12717.5805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/20/2015] [Indexed: 11/24/2022]
Abstract
We describe a case of a large simple neonatal ovarian cyst, which was managed successfully using "wait and watch" approach and serial ultrasound monitoring. A cystic lesion arising from right ovary was noted in antenatal ultrasound (USG) which was followed up with postnatal USG which revealed a large simple ovarian cyst without any complications. Patient was kept on expectant management with close clinical and USG monitoring. Cyst resolved spontaneously at 10 wk of age. A brief review of literature for likely aetio-pathogenesis and management is also presented.
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Affiliation(s)
- Mohd Aamir
- Fellow (Neonatology) Department of Pediatrics, Division of Neonatal Services, PGIMS , Rohtak, Haryana, India
| | - Harish Punia
- Junior Resident, Department of Pediatrics, PGIMS , Rohtak Haryana, India
| | - Poonam Dalal
- Associate Professor, Department of Pediatrics, PGIMS , Rohtak, Haryana, India
| | - Deepak Sharma
- DNB (Neonatology), Fernandez Hospital , Hyderabad, Telangana, India
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Trinh TW, Kennedy AM. Fetal Ovarian Cysts: Review of Imaging Spectrum, Differential Diagnosis, Management, and Outcome. Radiographics 2015; 35:621-35. [DOI: 10.1148/rg.352140073] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Antonakopoulos N, Agrapidis D, Karras G, Stefanidis K, Loutradis D. Torted large prenatally detected foetal ovarian cyst. J OBSTET GYNAECOL 2015; 35:848-9. [PMID: 25671519 DOI: 10.3109/01443615.2015.1009877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Antonakopoulos
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - D Agrapidis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - G Karras
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - K Stefanidis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
| | - D Loutradis
- a Department of Obstetrics and Gynecology , University of Athens Medical School, Alexandra Maternity Hospital , Athens , Greece
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Yilmaz Y, Demirel G, Ulu HO, Celik IH, Suna Oguz S, Erdeve O, Dilmen U. Four neonates with giant ovarian cysts: difficulties in diagnosis and decision making process. J Matern Fetal Neonatal Med 2011; 25:1508-10. [DOI: 10.3109/14767058.2011.636092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chinchure D, Ong CL, Loh AHP, Rajadurai VS. Neonatal Ovarian Cysts: Role of Sonography in Diagnosing Torsion. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n6p291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The purpose of this case series was to determine the sonographic features of neonatal ovarian torsion. Materials and Methods: Seven surgically proven cases of neonatal ovarian cysts were included in this retrospective study. The patients were divided into 2 groups, torsion and non-torsion. These 7 patients were evaluated for the clinical presentation, sonographic features, surgical and pathological findings. The findings on follow-up sonography after surgery were also noted. Results: The sonographic appearance was variable. Of the 4 cases with torsion, 2 lesions had internal echoes with ‘fish-net appearance’. The other 2 lesions were predominantly cystic on the sonography with internal echoes and echogenic nodule. A calcific focus was present in 1 of these echogenic nodules. One of the cysts had fluid-fluid level. In the non-torsion group, only 1 lesion had mixed echogenic appearance. The other 2 lesions were cystic with low level internal echoes in 1 of the cysts. The surgical procedure performed in the torsion group was salpingo-oophorectomy in 2 patients and oophorectomy in 1 patient. In 1 patient, cystectomy was attempted without success. In the non-torsion group, only cystectomy was performed with preservation of normal ovaries, which was confirmed on follow-up sonography. Conclusion: The sonographic features of cysts with ‘fish-net appearance’, fluid-debris level and cysts with echogenic nodule favour torsion. The former sign has so far not been described as a sonographic predictor for neonatal ovarian torsion.
Key words: Ultrasound, Ovary, Doppler, Fish-net appearance, Haemorrhage
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Affiliation(s)
| | | | - Amos HP Loh
- KK Women’s and Children’s Hospital, Singapore
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15
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The role of laparoscopy in the management of adnexal lesions in children. Surg Laparosc Endosc Percutan Tech 2011; 19:514-7. [PMID: 20027099 DOI: 10.1097/sle.0b013e3181c3132e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Laparoscopy has replaced laparotomy in a variety of surgical abdominal conditions. In pediatric patients the vast majority of adnexal lesions are benign. The aim of this study was to assess the safety and feasibility of laparoscopy in adnexal pathology in children. MATERIALS AND METHODS The case notes of girls with confirmed adnexal disorders treated in a single center between 1998 and 2008 were reviewed retrospectively. Demographic data, clinical and imaging features, surgical findings and procedures, pathologic features, complications, and outcomes were recorded. RESULTS Over a 10-year-period 21 patients underwent laparoscopic surgery. Median age at operation was 14 years (range: 2 d to 16 y). Laparoscopy was diagnostic in 1 patient whereas it was therapeutic in 14; 2 patients underwent a laparoscopy-assisted minilaparotomy. The procedure was converted to open in 4 patients due to technical difficulties. The most commonly performed procedures laparoscopically were cyst aspiration (n=6), cystectomy (n=4), unilateral oophorectomy (n=2), and cyst aspiration with deroofing (n=2). No operative or postoperative complications occurred. The overall mean postoperative length of stay was 2.3 days (range: 1 to 6 d); it was 1.8 days (range: 1 to 3 d) for patients who had laparoscopic procedures. Pathology revealed benign lesions in all cases. CONCLUSIONS In children with benign adnexal pathology, minimally invasive surgery is a feasible and safe approach. Additional benefits of shorter hospital stay, superior cosmetic result, and lesser risk of infertility, make laparoscopy a method of choice for managing pediatric patients.
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Abstract
The role of interventional radiology in paediatric nephrology and urology is gradually increasing. Some procedures (such as renal biopsy) are best performed using radiological techniques, some (such as ureteric stenting) by either radiologists or urologists, depending on clinical circumstances, and some (such as percutaneous nephrolithotomy) are usually performed jointly by urologists and interventional radiologists. This paper briefly reviews the main non-vascular interventional radiology techniques used in the genitourinary tract in children. Common procedures such as renal biopsy and nephrostomy and related procedures are emphasised.
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Affiliation(s)
- Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, WC1N 3JH, UK.
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17
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Neonatal ovarian torsion complicated by intestinal obstruction and perforation, and review of the literature. J Pediatr Surg 2010; 45:e5-9. [PMID: 20620297 DOI: 10.1016/j.jpedsurg.2010.02.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 02/20/2010] [Accepted: 02/22/2010] [Indexed: 11/23/2022]
Abstract
We present a case of neonatal ovarian torsion complicated by bowel obstruction and perforation and review the literature regarding the incidence of bowel obstruction in neonatal ovarian cysts, the presentation, and treatment. A term neonate was prenatally diagnosed with a cystic abdominal mass palpable on physical examination. A postnatal abdominal x-ray showed paucity of gas in the left hemiabdomen with rightward displacement of bowel loops. Exploratory laparotomy on day 2 of life revealed a large cystic mass in the left lower quadrant consistent with a torsed left ovary, an omental band causing strangulation of the bowel mesentery, and a perforation of the distal ileum. Our literature search revealed 19 reported cases of neonatal ovarian cysts resulting in bowel obstruction. Infants may present with a palpable abdominal mass, respiratory distress, as well as signs and symptoms of intestinal obstruction. Two mechanisms exist for bowel obstruction: adhesions caused by a torsed necrotic ovary and mass effect of a large ovarian cyst, often measuring 9 to 10 cm in diameter. Options to treat ovarian cysts include antenatal or postnatal aspiration, laparoscopy, and laparotomy. Cysts less than 4 to 5 cm can be observed, whereas operative intervention is indicated in symptomatic cases and in persistent or enlarging ovarian cysts.
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18
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Akın MA, Akın L, Özbek S, Tireli G, Kavuncuoğlu S, Sander S, Akçakuş M, Güneş T, Öztürk MA, Kurtoğlu S. Fetal-neonatal ovarian cysts--their monitoring and management: retrospective evaluation of 20 cases and review of the literature. J Clin Res Pediatr Endocrinol 2010; 2:28-33. [PMID: 21274333 PMCID: PMC3005663 DOI: 10.4274/jcrpe.v2i1.28] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/19/2009] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Neonatal ovarian cysts (NOC) are usually self-limiting structures. However, large or complex cysts may lead to severe complications. A standard guide to management, treatment and follow-up of NOC is not yet available. The aim of this study was to evaluate retrospectively the records of NOC patients from two medical centers. METHODS A total of 20 newborns with NOC were included in the study. The size and localization of the cyst, the age, the signs and symptoms at presentation, and the possible maternal and fetal-neonatal etiologic factors were recorded. Follow-up procedures and treatment modalities were evaluated. RESULTS The mean age at diagnosis was 34 gestational weeks. The cysts (mean size 53±15 mm) were predominantly in the right ovary (75%) and were evaluated as large cysts in 16 (80%) of the patients. In 5 of the patients with large cysts and in 1 of the 4 patients with small cysts, the cysts were evaluated as complex cysts. Torsion of the ovary was detected in five (25%) cases and these cases were treated surgically. Patients with simple cysts were closely followed by ultrasonography until the cysts disappeared. CONCLUSION To date, there is no precise guide for the monitoring and treatment of NOCs. Surgical treatment should always be performed in a way to protect the ovaries and to ensure future fertility. In our NOC series, it has been possible to apply a non-invasive follow-up program and minimally invasive surgical procedures.
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Affiliation(s)
- Mustafa Ali Akın
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, 38039 Kayseri, Turkey.
| | - Leyla Akın
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Kayseri, Turkey
| | - Sibel Özbek
- Bakırköy Maternity and Children Hospital, Department of Pediatrics, Division of Neonatology, İstanbul, Turkey
| | - Gülay Tireli
- Bakırköy Maternity and Children Hospital, Department of Pediatric Surgery, İstanbul, Turkey
| | - Sultan Kavuncuoğlu
- Bakırköy Maternity and Children Hospital, Department of Pediatrics, Division of Neonatology, İstanbul, Turkey
| | - Serdar Sander
- Bakırköy Maternity and Children Hospital, Department of Pediatric Surgery, İstanbul, Turkey
| | - Mustafa Akçakuş
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - Tamer Güneş
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - M. Adnan Öztürk
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
| | - Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Kayseri, Turkey
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Soccorso G, Walker J. A giant ovarian cyst in a neonate. J Pediatr Adolesc Gynecol 2009; 22:e17-20. [PMID: 19539190 DOI: 10.1016/j.jpag.2007.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 09/09/2007] [Accepted: 09/11/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antenatally diagnosed abdominal cysts are common, and frequently are ovarian in origin, which usually regress spontaneously. Surgery is indicated in the infantile period in case of very large, persisting or symptomatic cysts. Many surgeons feel that watchful waiting can be justified in newborns with simple and complex cysts. CASE We present a neonate with an ovarian cyst diagnosed antenatally by ultrasound (US) and showing persistent enlargement within 3 months after birth when reached a diameter of 13 cm. Assessment and treatment is described. CONCLUSION The extremely large, non-resolving ovarian cysts in neonates present a major challenge for clinicians and should be treated by surgery to avoid complications. We advocate laparotomy and cystectomy when possible to avoid unnecessary loss of functional ovarian tissue.
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Puligandla PS, Laberge JM. Lethal outcome after percutaneous aspiration of a presumed ovarian cyst in a neonate. Semin Pediatr Surg 2009; 18:119-21. [PMID: 19349004 DOI: 10.1053/j.sempedsurg.2009.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most surgeons agree that complex neonatal ovarian cysts, regardless of size, warrant operative intervention. Management of simple cysts >4 cm is still controversial, although many favor intervention because of the increased risk of torsion. Whereas laparoscopic cyst resection is favored by some, others prefer less invasive percutaneous needle aspiration. We present a newborn infant who was admitted with sepsis and respiratory failure after home delivery. Ultrasound done on day 8 to check for umbilical venous line placement incidentally showed a simple cyst measuring 3.6 x 5.9 x 6.9 cm that was presumed to be of ovarian origin. Percutaneous needle aspiration was atraumatic and revealed serous fluid, with a high estradiol level. Four days later, surgery was indicated for clinical deterioration with suspected hemorrhage into the cyst. We found a midgut volvulus with extensive necrosis secondary to a jejunal duplication cyst. Ovaries were normal and there was no evidence of malrotation. Postoperatively, after discussion with the parents, support was withdrawn and the child died. We should not rely solely on ultrasonographic features and fluid characteristics to diagnose a large neonatal abdominal cyst, but rather confirm the diagnosis with laparoscopy.
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Affiliation(s)
- Pramod S Puligandla
- Department of Surgery, Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
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Herman TE, Siegel MJ. Neonatal follicular ovarian hemorrhagic cyst. J Perinatol 2007; 27:805-7. [PMID: 18034168 DOI: 10.1038/sj.jp.7211858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T E Herman
- Department of Radiology, St Louis Children's Hospital, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA.
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Enriquez G. Comment on the paper entitled: "Percutaneous drainage as the treatment of choice for neonatal ovarian cysts". Pediatr Radiol 2007; 37:330; author reply 331-2. [PMID: 17216521 DOI: 10.1007/s00247-006-0399-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 12/13/2006] [Indexed: 11/29/2022]
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