title: Neonatal ovarian torsion complicated by intestinal obstruction and perforation, and review of the literature.
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.
authors.affiliation: School of Medicine, Wayne State University, Detroit, MI 48201, USA. cjeanty@med.wayne.edu
authors.forename: Cerine
authors.initials: C
authors.lastname: Jeanty
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Frayer
authors.forename: Renee
authors.initials: R
authors.lastname: Page
authors.forename: Scott
authors.initials: S
authors.lastname: Langenburg
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D007813:Laparotomy / Q000379:methods; D010048:Ovarian Cysts / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011860:Radiography, Abdominal; D012422:Rupture, Spontaneous; D014102:Torsion Abnormality / Q000150:complications* / Q000175:diagnosis / Q000601:surgery