Intrauterine ovarian torsion with autoamputation (IOTA) in fetuses was uncommon. The vague and non-specific symptomatology of IOTA makes early diagnosis challenging. Potential complications, such as hemorrhagic infarction of the adnexal structures with the subsequent sequelae, may occur. Moreover, therapeutic options, such as conservative or surgical management, for IOTA remain uncertain in the literature. We report three cases of IOTA, two of which were complicated by peritoneal adhesion or spontaneous bacterial peritonitis, confirmed surgically and through laboratory studies. A suspected diagnosis of this uncommon condition was made preoperatively in two cases. Our case reports provided additional information about this rare condition, including the occurrence of complicated bacterial peritonitis, in neonates and infants with IOTA. A review of the literature on imaging diagnosis and management options for IOTA is also included.

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.

An autoamputated ovary (AO) is an extremely rare circumstance with a few reports in the literature. We present a case of a 3-month-old girl with a history of vague abdominal symptoms as well as a known ovarian mass, which was initially suspected to be benign and regressing. On laparoscopy for pain and obstructive symptoms, she was found to have an AO. The pathology was consistent with necrotic and torsed ovarian tissue with superimposed infection and possibly a cystic non-malignant teratoma. AOs are thought to originate from a torsion and are typically diagnosed incidentally. This is an interesting case of an AO causing a partial small bowel obstruction.

In the last three decades, fetal ovarian cysts were diagnosed more frequently, due to technological improvement and the increasing use of prenatal screening ultrasound. Nonetheless, treatment uncertainties are still present, either prenatally or postnatally. Recently, significant innovations on diagnosis and treatment have been proposed and a more conservative, minimally invasive approach may be offered to the Pediatrician or the Surgeon who face with this condition during prenatal or neonatal age. (...).

History A 6-day-old female neonate presented to the outpatient pediatric surgery clinic for evaluation of a possible prenatal abdominal mass. The neonate was delivered at term via cesarean section due to macrosomia, with a reported birth weight of 11 lb 8.7 oz (5.23 kg). The patient's postnatal course was remarkable for resolving neonatal hyperbilirubinemia. A physical examination was remarkable for a palpable mass in the abdomen. Maternal risk factors included class II obesity, type 2 diabetes, and metabolic syndrome. Prenatal images obtained at an outside institution were not available at this time. Ultrasonography (US) of the abdomen and pelvis was performed 6 days after birth. Follow-up US at 29 days of life revealed no substantial change in the appearance of the findings. This patient remained asymptomatic, and gadolinium-enhanced (Magnevist; Bayer Pharma, Berlin, Germany) magnetic resonance (MR) imaging of the abdomen and pelvis was performed at 84 days of life. The mass was excised surgically at 89 days of life, and the patient had an uncomplicated postoperative course.

To review our experience with laparoscopic aspirations and minimally invasive surgeries for neonatal ovarian cysts and report the outcome of their follow-up.

Twenty-one neonates diagnosed as having ovarian cysts were retrospectively reviewed at our hospital from 2006 through 2013.

Of 21 neonates, 8 showed simple cysts and 13 showed complex cysts in their ultrasound scan. Laparoscopic aspiration was performed for all neonates with simple cysts. Torsion was found in 7 of 13 neonates with complex cysts. Three neonates underwent detorsion, while 2 neonates underwent oophorectomy. Two neonates already showed autoligation, showing a cystic mass, which was removed. The remaining 6 neonates with a complex cyst underwent only aspiration because no torsion was found. Of 14 neonates who underwent only aspiration, 11 showed no cyst, while 3 neonates, having a cyst with a size of less than 2 cm, underwent follow-up. Of 3 neonates who underwent detorsion, 1 showed an ovary without cyst, while 2 showed neither cyst nor ovary.

Laparoscopically, neonatal ovarian cysts may be diagnosed and aspirated simultaneously, simply, and safely.

Fetal ovarian cysts are the most frequent type of abdominal tumors in female fetuses with prenatal detection rate of more than 30%. The etiology of fetal ovarian cysts is unclear, but hormonal stimulation as well as presence of maternal diabetes, hypothyroidism, Rh iso-immune hemolytic disease and toxemia has been generally considered responsible for the disease. Complications of fetal ovarian cysts include compression of other viscera, cyst rupture, hemorrhage and, most frequently, ovarian torsion with consequent loss of the ovary. Management is controversial with several options described in the literature, including watchful expectancy, antenatal aspiration of simple cysts to prevent torsion and ovarian loss and finally, resection of all complex cysts in the neonatal period. To date, no case report has described recurrent complex cysts with rupture in the fetal period and recurrence of simple cyst in neonatal period. By presenting this case, we wanted to show that surgical intervention in case of prenatally diagnosed fetal ovarian cyst should be considered postnatally and only in symptomatic or complicated cases.

The evolution of minimally invasive surgery (MIS) in the newborn has been delayed due to the limited working space and the unique physiology. With the development of smaller instruments and advanced surgical skills, many of the initial obstacles have been overcome. MIS is currently used in specialized centers around the world with excellent feasibility. Obvious advantages include better cosmesis, less trauma, and better postoperative musculoskeletal function, in particular after thoracic procedures. However, the aim of academic studies has shifted from proving feasibility to a critical evaluation of outcome. Prospective randomized trials and high-level evidence for the benefit of endoscopic surgery are still scarce. Questions to be answered in the upcoming years will therefore include both advantages and potential disadvantages of MIS, especially in neonates. This review summarizes recent developments of MIS in neonates and the evidence for its use.

Abdominal cystic formations in neonates are rare entities and often diagnostic suspicion arises before birth as a result of routine ultrasonographic scans carried out during pregnancy. The aim of this study is to report the authors' experience with giant floating abdominal cysts in females.

The cases of antenatal abdominal cysts in females detected on ultrasound at the Department of Antenatal Diagnosis (Azienda Ospedaliera Universitaria Integrata, Verona, Italy) of the authors' institution between May 2005 and May 2013 were recorded together with their clinical and surgical findings.

16 patients underwent surgery for a giant floating abdominal cyst 2 to 6 days after birth. Postnatal ultrasound and laparoscopic exploration were useful to identify an antenatal torsion of the ovarian-tube complex. All patients were treated with a laparoscopic approach using 3-mm ports after video-assisted percutaneous aspiration of the cyst.

Giant abdominal cysts in female neonates should be treated immediately in order to avoid respiratory distress and complications. The laparoscopic approach is useful to confirm the diagnosis and to choose the most suitable treatment; giant floating abdominal cysts are closely correlated with torsion or autoamputation of the ovarian-tube complex.

To quantify our experience and that of the literature with diagnosis and management of the auto-amputated adnexa in a pediatric population.

Case series and literature review.

Tertiary care medical center.

Case series of pediatric patients (<18 years of age) with surgically documented adnexal auto-amputation collected from our medical center and the literature.

None.

Auto-amputated adnexa.

In addition to the 3 cases discussed from our institution, 91 cases of auto-amputated adnexa were identified in the literature dating back to 1943, for a total of 94 cases. Forty-nine percent (46/94) of the cases involved girls in a pediatric population (<18 years of age). Of these, the majority (n = 26) were identified in a subgroup of girls who were diagnosed with an adnexal cyst by antenatal ultrasound. Most of these neonates were asymptomatic at birth or had a palpable abdominal mass (n = 6) and at the time of surgical exploration were found to have an auto-amputated adnexa. 34 out of 46 cases were analyzed in detail. The right adnexa were involved in 56% of the cases. The most common presenting complaint verbalized by the older girls was pain; however, 8 cases were identified in asymptomatic girls undergoing unrelated diagnostic testing.

The auto-amputated adnexa is a rare finding in the pediatric population, but it must be considered as a possible explanation for the incidental finding of absence of the fallopian tube or ovary in the subgroup of patients who undergo surgery for any reason. Patients with an antecedent history of pelvic pain either chronic or intermittent in nature may be diagnosed with torsion or less frequently auto-amputation of the adnexa. A fetal "pelvic mass" or "ovarian cyst" may predispose the adnexa to torsion and subsequent auto-amputation either in-utero or post-delivery. Many of these antenatally diagnosed cysts and even subsequent auto-amputations are completely asymptomatic, however, and do not compromise fertility assuming the contralateral adnexa are normal. Thus expectant management is appropriate for small (less than 4 cm), asymptomatic simple cysts and even suspected auto-amputated adnexa in an asymptomatic patient.

A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.

Oophorectomy performed in children is extremely uncommon. We aimed to investigate the disease pattern and the association between the underlying pathology and the clinical presentation among those patients who had their ovaries removed in their childhood.

A retrospective study was performed on 41 consecutive children who underwent oophorectomy in a tertiary referral centre in the period between June 1995 and May 2008.

  The median age was 11 years, ranged from 11 weeks to 15 years at the time of surgery. The primary presentations were acute lower abdominal pain (n= 20), progressive abdominal distension or abdominal mass (n= 13), chronic abdominal pain (n= 3), irregular menses (n= 1), antenatal diagnosis (n= 3) and incidental finding (n= 1). Ultrasound examination was performed in 31 patients and positive findings of ovarian pathology were found in all but one examination. Twenty cases of ovarian torsion were confirmed intra-operatively. Patients presenting with acute abdominal pain were more likely to have torsion than other presentations (P < 0.01). Non-neoplastic conditions and ovarian neoplasms were found in 11 and 30 patients, respectively. The most common neoplasm was mature teratoma (52%). Malignant neoplasms included immature teratoma (n= 3), dysgerminoma (n= 1), mixed dysgerminoma + yolk sac tumour (n= 2), yolk sac tumour (n= 2) and juvenile granulose cell tumour (n= 1). Malignant neoplasms were found to have more chronic presentation and less torsion than benign pathologies (P < 0.05).

Although ovarian pathology is uncommon in children, a girl presenting with acute lower abdominal pain or progressive abdominal distension should raise the suspicion and prompt immediate investigation to rule out ovarian torsion or ovarian neoplasms.

The objective of this article was to present our experience in successfully managing a variety of abdominal cysts in newborns and infants using a mini-invasive technique performed in 8 cases using an umbilical laparoscopic port incision.

Assisted laparoscopic excision using an umbilical port incision was performed in 8 cases. Six were neonates (5 ovarian cysts and one hepatic cyst) and 2 were infants (6-months old with intestinal duplication and 11-months old with lymphatic malformation).

The procedure was performed with ease and was successful in all 8 cases. Oral feeding was started early after the surgical intervention. Seven patients were discharged the next day. The last case was discharged on the fifth day after surgery because of intestinal resection.

This proposed mini-invasive technique using the umbilical port incision proved to be less invasive, easier, and less technically demanding than the classic laparoscopic approach and, hence, may be applied to different abdominal cystic pathologies in newborns and infants.

The advent of minimally invasive surgical techniques in the neonate has been delayed due to the limited working space and the unique physiology of the newborn. In the last decade, with the introduction of new instruments and techniques, many of the initial problems have been solved making minimally invasive surgery feasible for a variety of indications in the neonate and a favored approach in specialized centers around the world. Although an increasing number of reports document the feasibility of this exciting technique, data demonstrating its benefit compared to conventional surgery is limited. This review focuses on recent developments in minimally invasive surgery in neonates and the evidence for its use.

Laparoscopy has replaced laparotomy in a variety of surgical abdominal conditions. In pediatric patients the vast majority of adnexal lesions are benign. The aim of this study was to assess the safety and feasibility of laparoscopy in adnexal pathology in children.

The case notes of girls with confirmed adnexal disorders treated in a single center between 1998 and 2008 were reviewed retrospectively. Demographic data, clinical and imaging features, surgical findings and procedures, pathologic features, complications, and outcomes were recorded.

Over a 10-year-period 21 patients underwent laparoscopic surgery. Median age at operation was 14 years (range: 2 d to 16 y). Laparoscopy was diagnostic in 1 patient whereas it was therapeutic in 14; 2 patients underwent a laparoscopy-assisted minilaparotomy. The procedure was converted to open in 4 patients due to technical difficulties. The most commonly performed procedures laparoscopically were cyst aspiration (n=6), cystectomy (n=4), unilateral oophorectomy (n=2), and cyst aspiration with deroofing (n=2). No operative or postoperative complications occurred. The overall mean postoperative length of stay was 2.3 days (range: 1 to 6 d); it was 1.8 days (range: 1 to 3 d) for patients who had laparoscopic procedures. Pathology revealed benign lesions in all cases.

In children with benign adnexal pathology, minimally invasive surgery is a feasible and safe approach. Additional benefits of shorter hospital stay, superior cosmetic result, and lesser risk of infertility, make laparoscopy a method of choice for managing pediatric patients.

Abdominal cystic formations in newborns are relatively common and often diagnostic suspicion arises before birth as a result of ultrasound scans carried out during pregnancy. Prenatal ovarian torsion is a rare condition very difficult to manage in the first days of life. We report and discuss the management of prenatal ovarian torsion with a free-floating abdominal cyst detected on prenatal ultrasound.

We recorded the cases of antenatal abdominal cysts detected on ultrasound at the Department of Antenatal Diagnosis between January 2003 and January 2007. Only patients with a free-floating cyst were included in the study. Clinical and surgical findings were then recorded.

Two out of 57 patients underwent surgery for a free-floating abdominal cyst during the second day of life. Postnatal ultrasound, Doppler ultrasound, and laparoscopic exploration were useful to identify an unusual presentation of antenatal ovarian torsion with a complete atresia of the Fallopian tube.

The cases reported in this study suggest that a good clinical approach to all cases of abdominal cysts detected on prenatal ultrasound scans require postnatal Doppler and abdominal ultrasound with a laparoscopic exploration. Free-floating abdominal cysts are rare but, at the same time, strictly correlated with autoamputation of the ovary/Fallopian tube complex.

A case of ovarian autoamputation in an asymptomatic neonate is presented. An abdominal cyst was detected in a 30-week-gestation fetus on an antenatal ultrasound scan (USS). Postnatal USS confirmed the presence of a cyst in the right pelvis and revealed it to be 3.2 cm in diameter. CT and MRI revealed cyst wall calcification and intracystic hemorrhage. To confirm the diagnosis and treatment, the cyst was surgically removed. During the operation, a free autoamputated right ovarian cyst was found and removed from the abdomen. Ovarian cyst autoamputation is an extremely rare complication. In this article, we review the infantile ovarian autoamputation cases reported in the literature and assess their diagnosis and therapeutic management.

Since its first detailed description in 1995, the laparoscopic management of neonatal ovarian cysts has typically required multiple incisions, specialized equipment, and advanced laparoscopic skills. After some initial frustration with neonatal laparoscopy, we developed a simplified single-incision laparoscopic-assisted transumbilical extracorporeal cystectomy (LATEC). This paper reviews our experience with this technique and compares outcomes to those of our other surgically managed neonatal ovarian cyst patients.

A retrospective record review of 20 patients treated surgically between 1992 and 2006. Student's t-tests were used for comparisons (P<0.05 was significant).

Means were: age, 11 days; weight, 3.7 kg; and cyst diameter, 5.0 cm. Nineteen patients were diagnosed prenatally, at the mean gestational age of 33 weeks. Twelve of 20 (60%) had torsed cysts (1 bilateral). Three of 13 torsed cysts (23%) were less than 4 cm diameter (range, 2.9-3.5). Laparotomies were transverse lower abdominal incisions. Laparoscopic operations used 2 (3 patients) or 3 incisions (2 patients). LATEC involved transumbilical laparoscopy, complete cyst aspiration, and then cyst evisceration through the umbilicus for either ovarian cystectomy (simple cysts) or salpingo-oophorectomy (torsed cysts). Laparoscopic patients had similar time to feeds, length of stay, and postoperative narcotic requirements, when compared to laparotomy patients (P=nonsignificant). LATEC patients had shorter surgical times, more rapid advancement to full enteral feedings, shorter length of hospital stay, and equal ovarian preservation, when compared to laparoscopy. Cosmetic results with LATEC were outstanding.

Both laparoscopic and "open" approaches have acceptable perioperative morbidity and rapid recovery. LATEC is a relatively simple procedure, which combines laparoscopy and traditional extracorporeal surgery, and may be successfully performed by experienced pediatric surgeons and with a single incision.

Abdominal cystic formations in newborns are relatively common and often diagnostic suspicion arises before birth as a result of ultrasound scans carried out during pregnancy. Prenatal ovarian torsion is a rare condition very difficult to manage in the first days of life. We report and discuss the management of prenatal ovarian torsion with a free-floating abdominal cyst detected on prenatal ultrasound.

We recorded the cases of antenatal abdominal cysts detected on ultrasound at the Department of Antenatal Diagnosis between January 2003 and January 2007. Only patients with a free-floating cyst were included in the study. Clinical and surgical findings were then recorded.

Two out of 57 patients underwent surgery for a free-floating abdominal cyst during the second day of life. Postnatal ultrasound, Doppler ultrasound, and laparoscopic exploration were useful to identify an unusual presentation of antenatal ovarian torsion with a complete atresia of the Fallopian tube.

The cases reported in this study suggest that a good clinical approach to all cases of abdominal cysts detected on prenatal ultrasound scans require postnatal Doppler and abdominal ultrasound with a laparoscopic exploration. Free-floating abdominal cysts are rare but, at the same time, strictly correlated with autoamputation of the ovary/Fallopian tube complex.

Torsion of the uterine adnexa is an uncommon occurrence in infants, but when it does occur, the consequences may be catastrophic.

A 4-month-old female presented with sudden cardiac and respiratory arrest. There were no prior signs of illness. The infant was resuscitated and survived for one day after the event. Autopsy revealed a left ovarian cyst with torsion. Necrosis of the transverse colon was also seen. Other organs revealed signs of shock. The cause of death was felt to be related to the torsion.

Torsion of the uterine adnexa is rare in infants. In the few reported cases, antecedent symptoms were present. Clinicians should be aware of this possibility and include it in the differential diagnosis of death in infancy.

Since Tan and Bianchi (Br J Surg. 1986;73:399) reported umbilical incision as an access for pyloromyotomy in infantile hypertrophic pyloric stenosis, many pediatric surgeons have used this approach for a number of other procedures. Because of the long pedicle with good mobility and the frequent intraabdominal position of the neonatal ovarian cyst, we attempted to manage it via the transumbilical route.

All patients were treated under intubation general anesthesia. Semicircular infraumbilical incision was made, and the abdomen was entered through a transverse fascial incision. The partially collapsed cyst after aspiration was exteriorized through the incision for cystectomy, partial deroofing, or adnexectomy.

From May 2000 to December 2006, 6 female newborns with ovarian cysts were treated via the transumbilical route. There were no complications from surgery. The operation time and duration of hospital stay were short. The cosmetic appearance after the procedure was good.

The initial result suggests that transumbilical management for neonatal ovarian cysts may be a good alternative procedure when laparoscopic equipment is unavailable or experienced technique is lacking.

The etiology of ovarian cysts varies with the developmental stage and hormonal milieu of the patient. In general, most ovarian cysts are functional in nature and usually resolve without treatment. Treatment is indicated if the diagnosis is in question, the cyst persists, or the patient is symptomatic. Laparoscopy has become the approach favored by most pediatric surgeons for the treatment of ovarian cysts. All surgical procedures for ovarian cysts should spare functional ovary as much as is technically possible. Simple cysts should be fenestrated. Complex or functional cysts should be excised, with preservation of the remaining ovary.

Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. Clinical presentation is nonspecific, and diagnosis is based on a high index of suspicion. Ultrasound scan remains the most useful investigation, but blood flow on Doppler examination does not exclude ovarian torsion. Current recommendations of treatment strongly support ovary conservation, and macroscopic appearance of the ovary is not a reliable indicator of the degree of necrosis and potential for ovary recovery. For children with ovarian torsion, laparoscopic detorsion should be performed with strong consideration of oophoropexy. An underlying ovary lesion such as mature teratoma or functional cyst is found in most cases; however, the risk of cancer in these patients is extremely low. If there is concern of a mass or underlying pathology, then follow-up ultrasound, resolution of edema and interval laparoscopic treatment may be required.