Neonatal ovarian torsion complicated by intestinal obstruction and perforation, and review of the literature |
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Authors: | Cerine Jeanty Elizabeth A Frayer Scott Langenburg |
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Institution: | a School of Medicine, Wayne State University, Detroit, MI 48201, USA b Department of Obstetrics and Gynecology, Hutzel Women's Hospital, Detroit, MI 48201, USA c Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, MI 48201, USA |
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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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Keywords: | Neonatal ovarian torsion Intestinal obstruction Neonatal ovarian cyst complications Bowel perforation |
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