Dr.SHOBIKA,Dr.Praveena,Dr.Bindu,Dr C Jayakumar
Aims Kochi
Fourteen years old female presented with complaints of abdominal pain for 2 days duration.
H/o 5 episodes of non bilious non projectile vomiting of 1 day duration.
No h/o painful micturition, bleeding PV,trauma,loose stools,altered sensorium
Birth history:1st child of NCM
Antenatal history: Uneventful
Natal history: Term/AGA/NVD/B.w-3.4kg/CIAB
Postnatal history: Uneventful
No previous hospital admissions in the past
Developmentally normal and immunized upto age.
Family history:Grandmother -known ovarian cancer and on chemotherapy
O/E:
Child was conscious,oriented
Vitals-
T-98F,PR-99b/min,RR-17b/min,Spo2-100%on RA,BP-101/68mmhg
S/E:
P/A- Soft,Diffuse tenderness
CVS-S1S2 +,No murmurs
CNS-normal
RS- NVBS,B/L AE
Differentials considered:
Acute gastritis
Appendicitis
Pancreatitis
Cholecystitis
Ovarian cyst
Investigations:
TLC-3.36ku/ml,N/L-66.1/22.6%,Hb-11.3g/dl,Urea-10.8,Creatinine-0.53,
CRP-2.78mg/l
USG abdomen showed torsion of ovarian cyst
The child was taken up to for laparoscopic oophorectomy.
Intra operatively large right ovarian cyst with torsion noted,cyst was deported and observed for vascularity,cyst fluid aspirated,cyst with ovary was removed through a small pfannensteil incision though the vascularity was with normal hair and fat content was seen hence oophorectomy was done.
Post operative periods were uneventful.
The child was discharged with oral antibiotics for a week.
OVARIAN CYST:
Cystic ovarian masses occur in female infants, children, and adolescents.
Symptoms or signs:
Abdominal pain or distension, palpable mass.
Cystic ovarian lesions may be due to enlargement of a cystic follicle (physiologic cyst, also called a functional cyst) or benign or malignant ovarian tumors.
Complications of ovarian cysts include ovarian torsion, rupture, intracystic hemorrhage, gastrointestinal or urinary tract obstruction.
Ovarian torsion occurs in girls of all ages.
The incidence was 4.9 per 100,000 females age 1 to 20 years
Clinical features – Signs and symptoms of ovarian torsion include severe unilateral lower abdominal pain of sudden onset of nausea, vomiting, pallor, and, rarely, low-grade fever.
Ovarian torsion is more common on the right side and can be difficult to differentiate from acute appendicitis.
Intermittent pain that resolves without therapy may indicate torsion without complete occlusion of the vascular blood supply, particularly if the pain is associated with vomiting.
Any patient with an adnexal cyst/mass with pain and nausea/vomiting should be evaluated for tubal and/or ovarian torsion.
Investigations:
Complete blood count show leukocytosis.
USG abdomen
Management:
Ovarian or tubal torsion is a surgical emergency.
Surgery is always indicated at the time of diagnosis of adnexal torsion because a torsed ovary and/or tube can usually be salvaged untwisting the vascular pedicle.
Untwisting can be accomplished laparoscopically.