Surgical aspects of the treatment of neonatal ovarian cysts in girls

Introduction. Neonatal ovarian cysts develop in case of hormonal imbalance in the mother-placenta-fetus system. Cystic transformation in the ovary may cause appendage torsion which leads to follicular necrosis and loss of ovarian reserve. Most often, torsion occurs in the utero, but in premature girls- due to the specific hormonal status - the risk of cyst growth and its torsion remains in the postnatal period. Currently, a unified approach to the surgical treatment of neonatal ovarian cysts is absent.Material and methods. In the department of pediatric surgery for malformations in the Perinatal Center of the Amazov National Medical Research Center, 34 girls with ovarian cysts were examined during 2012-2020; 9 of them (27%) were premature. In the presented observation, we faced an ovarian cyst in the fetus of 30 week gestation.Results. The cyst looked uncomplicated, but had the enormous size, so we discussed a possibility to perform an intrauterine puncture. However, due to severe hemolytic disease of the fetus and premature delivery, the intervention was not carried out. By the third week of life, torsion of the cystic-transformed ovary developed; necrosis and self-amputation of the right uterine appendage were revealed intraoperatively. By the age of three months, cystic transformation of the only ovary developed. Timely performed laparoscopic fenestration was organ-sparing. Further follow-up revealed preserved and normally growing single ovary what confirmed the right choice of surgical tactics.Conclusion. Dynamic ultrasound examination of the pelvic organs is indicated to all premature girls, at least once every two weeks (in case of revealed ovarian cyst - weekly). We consider it reasonable to make the laparoscopic fenestration of uncomplicated cysts that have size of 3 cm and more. Newborn girls with ovarian cysts should be under the joint control of pediatrician and pediatric gynecologist for developing an individual follow-up plan.

Two cases of non-parasitic splenic cysts and spleen-preserving therapy

We review two different presentations of non-parasitic splenic cysts, both of which are post-traumatic in aetiology. The first case was of slower onset and was managed electively. The second case was of acute onset and was managed as an emergency. Non-parasitic splenic cysts are uncommon and the optimal management strategy for them is not well defined. Historically, treatment has been with open splenectomy; however, infection rates following this surgery have been high, making it an unattractive management option. Both cases were managed successfully with laparoscopic fenestration with no recurrence at subsequent follow-up.

Laparoscopic fenestration surgery of a large primary splenic cyst

Splenomegaly is a major and perhaps the only concern pertaining to spleen for surgeons. Splenic cysts are rare presentations as splenomegaly, with about 800 cases reported so far. Presenting a case report of a 19 years old boy presented with a mass in the abdomen below the rib cage on the left side since 1 year. No other associated complaints. On clinical evaluation a soft cystic mass of size 10×10 cm approximately, was felt extending upto and just above the umbilicus, occupying the left hypochondrium, epigastrium, left lumbar and part of umbilical region. On contrast enhanced computed tomography (CECT) abdomen and pelvis, a well-defined, rounded cystic swelling arising from the spleen and abutting the surrounding structures was noted. Clinically diagnosing it as a primary splenic cyst and after thorough preoperative evaluation the patient was planned for laparoscopic fenestration surgery of the cyst. Surgery involved aspirating, deroofing of the cyst with omental packing of the cyst cavity. This surgery is a novel minimally invasive spleen preserving approach to such types of splenic cysts. This approach carries the least morbidity and recurrence rate among its other options.

Polycystic liver disease: a rare case study

Polycystic liver disease is a rare inherited disorder which affects 1 in 1,00,000 population. There are two forms of polycystic liver disease (PLD) i.e. isolated PLD and autosomal dominant PLD which is associated with renal cysts. PLD is usually asymptomatic and incidentally detected. Some may present with complaints of abdominal distension, bloating, early satiety, weight loss. Computed tomography (CT) or magnetic resonance imaging is the investigation of choice to diagnose polycystic liver disease. Below we report you a case of 55-year-old female who came with the complaints of pain abdomen since 8 days and was diagnosed as polycystic liver disease on CT, who received treatment by laparoscopic fenestration surgery of cysts and showed symptomatic improvement.