Dr. Mahak Bhasin, Dr. Sajitha Nair, Dr. Naveen Viswanath (Paed surgery)Dr. Sindhu, Dr. Sreya, Dr CJayakumar Department of Pediatrics, AIMS, Kochi
Three month old female child partially immunised developmentally normal was brought for evaluation for recurrent cough due to which she was not being operated for an antenatally detected adnexal mass.
Faulty feeding practices were identified but ba had normal auxology. Clinical examination was also normal. There was no distension of abdomen.
Child was evaluated in view of different adnexal masses and was found to have increase in size of the mass with increased echogenecity. Initially mass was 4×3 cm antenatally. Postnatal sonogram showed an increase in dimension to 2.8×4.5×4.8 cm with internal echoes and layered debris.
Our differentials were–
Ovarian Cyst
Mesenteric Cyst
Hydronephrosis with urinoma
Choledochal cyst
Urachal Cyst
Urogenital Sinus
Splenic Cyst
Anterior Meningocoele with Sacrococcygeal terratoma
Pediatric Surgery Consultation was sought and child was planned for a laproscopic excision of the mass after medical optimisation for the recurrent cough. Child was operated laparoscopically.
Histopathology showed collapsed ovarian cyst wall lined with denuded epithelium infarction necrosis.
This 3 month old child had a left ovarian cyst with antenatal torsion which presented as an asymptomatic complex cyst postnatally ie. cysts containing debris/septae/solid cysts/cysts more than 2cm. Ultrasound evidence of torsion is found in 92% of surgical cases at or before birth, which suggests that most torsion occurs prenatally; the risk of postnatal torsion may be low.
While ovarian cysts are common in female neonates–not requiring any active inerventions and generally resolving spontaneously( about 46%), they need to be followed up for red flag signs–
1. Persistence of cysts beyond 4 months
2. Enlarging Cysts
3. Complex Cysts ie. Cysts containing debris/septae/solid cysts/cysts more than 2cm
4. Symptomatic Cysts
5. Changing appearance from simple to complex cysts
Larger cysts are more prone for torsion–antenatally or postnatally/can rupture/cause obstructions in the genitourinary/gastrointestinal tracts. There might be abdominal dystocia during birth or respiratory distress post natally due to the mass effect of the cyst on the diaphragm. These cysts are rarely malignant with them accounting for only 1% of tumors in girls.
Ovarian cysts in the adolescent may be asymptomatic, associated with menstrual irregularities or pelvic pain. Large cysts may cause urinary frequency, constipation, or feelings of pressure in the lower abdomen. These are also managed conservatively with surgical intervention only needed for larger or complex cysts at risk for torsion and ovarian loss.
Carry Home Message—Serial monitoring of ovarian cysts can save lives.