Parlak Ayse, Celik Fatih, Turedi Sezer Bilge, Yilmaz Mehmet Ugur, Kilic Nizamettin, Kiristioglu Irfan, Balkan Emin, Dogruyol Hasan
Department of Pediatric Surgery, Uludag University Medical Faculty, 16059, Bursa, Turkey.
Division of Pediatric Urology, Department of Pediatric Surgery, Uludag University Medical Faculty, Bursa, Turkey.
Pediatr Surg Int. 2022 Nov;38(11):1649-1655. doi: 10.1007/s00383-022-05192-1. Epub 2022 Aug 14.
Antenatal auto-amputation of the ovary is an extremely rare event, and its diagnosis is difficult. We aimed to retrospectively review the cases with antenatal auto-amputation, where the diagnosis was made based on detection of free-floating cyst during surgery.
Patients diagnosed with auto-amputated ovary during the surgery between 2012 and 2021 were included in the study. The data were reviewed retrospectively. Clinical, radiological, surgical, and histopathological findings were recorded.
Eight patients underwent surgery for an abdominal cystic mass. The age range of patients who were operated was from 21 days to 9 months. None of the patients had symptoms, except one patient who had a large cyst and was vomiting. Prenatal ultrasound examination indicated an intra-abdominal cyst in all patients, but auto-amputated ovary diagnosis was not made. Differential postnatal diagnoses included an ovarian cyst, ovarian teratoma, tuba-ovarian torsion, mesenteric lymphatic malformation, and intestinal duplication cyst. Only one patient had an auto-amputated ovary suspicion in computed tomography. Laparoscopic exploration (n: 7) or laparotomy (n: 1) was performed. Histopathologic examination was necrosis and calcification (n: 6), necrosis (n: 1), and serous cystadenoma and necrosis (n: 1).
We suggest that laparoscopy should be used for diagnosis and treatment of antenatal intra-abdominal cysts that persist postnatally because of diagnostic dilemmas. We recommend in patients diagnosed with auto-amputated ovary that the other ovary should be carefully monitored and followed up in terms of ovarian cyst, due to the possible risk of torsion.
产前卵巢自截是一种极其罕见的情况,其诊断较为困难。我们旨在回顾性分析产前卵巢自截的病例,这些病例的诊断是基于手术中发现的游离囊肿。
纳入2012年至2021年间手术中诊断为卵巢自截的患者。对数据进行回顾性分析。记录临床、影像学、手术及组织病理学检查结果。
8例患者因腹部囊性肿物接受手术。手术患者年龄范围为21天至9个月。除1例因巨大囊肿出现呕吐症状外,其余患者均无症状。产前超声检查显示所有患者均有腹腔内囊肿,但均未做出卵巢自截的诊断。产后鉴别诊断包括卵巢囊肿、卵巢畸胎瘤、输卵管卵巢扭转、肠系膜淋巴管畸形及肠重复囊肿。仅1例患者在计算机断层扫描中有卵巢自截的可疑表现。行腹腔镜探查(7例)或剖腹手术(1例)。组织病理学检查结果为坏死及钙化(6例)、坏死(1例)、浆液性囊腺瘤及坏死(1例)。
我们建议,由于诊断困难,对于产后仍存在的产前腹腔内囊肿,应采用腹腔镜进行诊断和治疗。对于诊断为卵巢自截的患者,鉴于存在扭转的可能风险,建议对另一侧卵巢仔细监测并随访其囊肿情况。