neonatal ovarian cysts - department of surgery at suny ...case 1 16day f nsvd at full term with...

Neonatal Ovarian Cysts

Praz Patcha 12 Dec 2013

www.downstatesurgery.org

Case 1

16day F NSVD at full term with known history of 2cm ovarian cyst at 20 weeks, admitted with sepsis with fever of 101, dehydration, distension; Birth u/s at OSH demonstrated 6cm cyst with layering debris; Baby was resuscitated in NICU;


Case 1

VS 101.0 137 40 88/53 Sunken fontanelles; Lethargic; Abd distended; Ballotable mass RLQ; cbc 14.7 / 14 / 42 / 694 46% 18.2 51% bmp 140 / 5.8H / 109 / 18 / 3 / 0.1


Case 1

Repeat u/s demonstrates 5 x 5 x 4 cm R ovarian cyst with layering debris;


OR

Exploratory laparotomy, R salpingoopherectomy, L ovarian cystectomies

– hemorrhagic intraperitoneal fluid – R ovarian torsion with atrophy of fallopian tube – 4 x twists of R adnexa – L ovary with multiple small cysts, viable ovary


Case 1

Discharged POD 5 after tolerating feeds; Path: R infarcted ovary, fibrotic fallopian tube; coagulative necrosis;


Case 2

3day F emergent c/s at term for arrest of labor with known prenatal ovarian cyst; Follow up u/s on DOL 2 with b/l cysts with significant layering; Referred by pediatrician for emergent surgical consultation;


Case 2

VS 98.1 108 42 70/39 NAD; Distended abdomen; Ballotable b/l lower abd masses; cbc 8.7 / 15 / 45 / 389 bmp 139 / 6.7 / 111 / 18 / 4 / 0.1 / 110


Case 2

• Repeat u/s demonstrated b/l large ovarian cysts with hemorrhagic layering c/w infarction


OR

• Exploratory laparotomy, b/l salpingoopherectomy – purulent intraperitoneal fluid – terminal ileum adherent to R adnexa – b/l hemorrhagic infarcted adnexa


Case 2 www.downstatesurgery.org

Case 2

Discharged uneventfully on POD 2; Path: b/l necrotic ovarian cysts; infarcted ovaries;



• Non-neoplastic ovarian tumors

• Arise from mature follicles (FSH, LH, estro,

hCG)

• Typically self-limited due to postnatal decrease in hormones



• 84% of 77 imaged patients from birth to 24mo

demonstrated ovarian cysts (Cohen)

• Majority inactive, but occasionally secretory

• Size is the major factor in clinical management


Risks

• Size 5cm and above, increased risk of torsion

• Simple vs Complex – prepubertal complex indicates torsion or

malignancy

– adolescent complex indicates hemorrhagic


Distinguishing Features

• Likely torsion – fluid debris – clot – septations

• Likely a prenatal event

• Ovary likely lost despite intervention


Recommend

• 0 – 4 cm: observation, serial u/s

• 5cm or long adnexal pedicle: resect or aspirate, attempt to spare ovarian tissue

• Intrauterine aspiration controversial, highly risky


Thank you


neonatal ovarian cysts - department of surgery at suny ...case 1 16day f nsvd at full term with...

Documents