Quiste gigante de ovario / Giant cyst of ovary

Introducción: Los tumores de gran tamaño han sido descritos a través de la historia, entre ellos los ginecológicos y los de ovario cuando pesan más de 12 kg constituyen una rareza médica. Las masas tumorales en hemiabdomen inferior son causas frecuentes de consulta en cirugía general. Dentro de estas, los quistes de ovarios son los que con más frecuencia se diagnostican. Objetivo: Describir el caso de un quiste gigante de ovario en una paciente que fue atendida en consulta de cirugia general por aumento de tamaño en el abdomen de varios años de evolución. Caso clínico: Se expone el caso de una paciente femenina, con antecedentes de salud, que acude al servicio de cirugía general por aumento de volumen del abdomen, progresivo, insidioso de 2 años de evolución. Se diagnostica masa quística dependiente de ovario y en el transoperatorio se constata una tumoración quística del ovario que en el análisis histopatológico informa un cistoadenoma seroso de ovario. Conclusión: Los tumores del ovario no son tan frecuentes como los del útero y los de la mama, pero constituyen el tercer grupo de tumores benignos y malignos de la mujer. Se presentó el caso por lo infrecuente que resulta, la escasa frecuencia de reporte de estos casos lo cual aporta conocimiento a la comunidad médica sobre el tema(AU)

Introduction: Large tumors have been described throughout history, including gynecological tumors, and ovarian tumors when they weigh more than 12 kg constitute a medical rarity. Tumor masses in lower hemiabdomen are frequent causes of consultation in general surgery. Within these, ovarian cysts are the most frequently diagnosed. Objective: To describe the case of a giant ovarian cyst in a patient who was treated in a general surgery consultation due to an increase in abdomen size of several years of evolution. Clinical case: The case of a female patient, with a history of health, which goes to the general surgery service due to an increase in abdomen volume, progressive, insidious of 2 years of evolution, is presented. Ovarian-dependent cystic mass is diagnosed and a cystic tumor of the ovary is found in the transoperative period, which in the histopathological analysis reports a serous ovarian cystadenoma. Conclusion: Ovarian tumors are not as frequent as those of the uterus and those of the breast, but they constitute the third group of benign and malignant tumors of women. The case was presented because of the infrequent result, the low frequency of reporting these cases, which brings knowledge to the medical community on the subject(AU)

Quiste gigante de ovario / Giant cyst of ovary

RESUMEN Históricamente, se describen como tumores de gran tamaño aquellos que pesan más de 12 Kg, entre ellos los ginecológicos y los de ovario; sobre todo antes del advenimiento de la ecografía y en poblaciones de mala situación socioeconómica y nivel cultural, como en los países del continente africano. Se presentó un caso de quiste gigante del ovario, en una paciente de 45 años de edad, que fue atendida en el Servicio de Cirugía General del Hospital Municipal de Bocoio, provincia de Benguela, República de Angola, en el año 2015. Se presentó por un aumento de tamaño del abdomen de varios años de evolución Se le diagnosticó una masa quística dependiente de ovario, por ultrasonografía por no contar con otro medio de diagnostico imagenologico. Se confirmó a través de una laparotomía exploradora la presencia de una tumoración quística gigante del ovario de 20 kg de peso. Esta patología es poco frecuente en la actualidad debido al desarrollo de la Cirugía y de los medios de diagnósticos que permiten su detección precoz. El estudio anatomopatológico ulterior informó un cistoadenoma seroso de ovario izquierdo. La evolución de la paciente fue favorable. Se consideró un caso interesante por lo infrecuente, la poca existencia de reporte de estos casos en la literatura, sobre todo en Cuba, lo que contribuye a aportar conocimientos a la comunidad médica (AU).

ABSTRACT Through the history those tumors weighting more than 12 kg have been described as great size tumors, among them the gynecological and the ovarian ones, especially before the appearance of the ultrasonography, and among populations of bad socio-economic situation and low cultural level, like in the countries of the African continent. The authors presented the case of a giant ovarian cyst in a patient aged 45 years, who assisted in the Service of General Surgery of the Municipal Hospital of Bocolo, province of Benguela, Republic of Angola, in 1915. She arrived to the consultation due to an increase of the abdominal size of several years of evolution. By ultrasonography because there was no other mean of imaging diagnosis, the diagnosis was an ovary-dependent cystic mass. Using laparoscopy it was confirmed the presence of a giant cystic tumor of the ovary of 20 kg weight. This disease is few frequent nowadays due to the development of Surgery and diagnostic means allowing a precocious detection. The subsequent anatomopathologic study informed a serous cystadenoma of the left ovary. The patient had a satisfactory evolution. The case was considered interesting given its infrequency, the scarce existence of reports of cases like this in the literature, especially in Cuba, contributing with knowledge for the medical community (AU).

The impact on ovarian reserve of different hemostasis methods in laparoscopic cystectomy: a systematic review and meta-analysis / Impacto das diferentes técnicas hemostáticas empregadas na ooforoplastia videolaparoscópica sobre a reserva ovariana: revisão sistemática e meta-análise

Abstract Objective The objective of this review was to analyze the impact on ovarian reserve of the different hemostatic methods used during laparoscopic cystectomy. Data Sources The studies were identified by searching electronic databases (MEDLINE, Embase, Cochrane, LILACS) and scanning reference lists of articles. Methods of Study Selection We selected clinical trials that assessed the influence of hemostatic techniques on ovarian reserve in patients with ovarian cysts with benign sonographic appearance submitted to laparoscopic cystectomy by stripping technique. The included trials compared different laparoscopic hemostatic techniques: suture, bipolar electrocoagulation, ultrasonic energy and hemostatic sealants. The outcomes evaluated were level of serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). The possibility of publication bias was evaluated by funnel plots. Tabulation, Integration and Results Twelve trials involving 1,047 patients were evaluated. Laparoscopic suturewas superior to bipolar coagulationwhen evaluating serum AMHand AFC, in the 1st, 3rd, 6th and 12thmonth after surgery. In the comparison between bipolar and hemostatic sealants, the results favored the use of hemostatic agents. The use of ultrasonic energy was not superior to the use of bipolar energy. Conclusion We recommend suture for hemostasis during laparoscopic cystectomy.

Resumo Objetivo O objetivo desta revisão foi comparar o impacto dos diferentes métodos hemostáticos na reserva ovariana durante a ooforoplastia laparoscópica. Fontes de Dados Os estudos foram identificados através da pesquisa de bases de dados eletrônicas (MEDLINE, Embase, Cochrane, LILACS) e listas de referência de artigos. Seleção dos estudos Selecionamos ensaios clínicos que avaliaram a influência das técnicas hemostáticas na reserva ovariana em pacientes com cistos ovarianos com aspecto ultrassonográfico benigno submetidos à ooforoplastia laparoscópica pela técnica de tração e contra-tração. Os estudos incluídos compararam as técnicas hemostáticas: sutura, energia bipolar, energia ultrassônica e selantes hemostáticos. Coleta de dados Os desfechos avaliados foram o hormônio antimülleriano e a contagem de folículos antrais. A possibilidade de viés de publicação foi avaliada por gráficos de funil. Síntese dos dados Doze estudos envolvendo 1.047 pacientes foram avaliados. A sutura foi superior à coagulação bipolar, e, na comparação entre selantes e energia bipolar, os resultados favoreceram o uso do primeiro grupo. O uso de energia ultrassônica não foi superior ao uso da energia bipolar. Conclusão Em conclusão, recomendamos a sutura para hemostasia durante a ooforoplastia laparoscópica.

Tumores ováricos en niñas y adolescentes / Ovarían masses in infant-juvenile age

Introducción. El tratamiento quirúrgico adecuado para las pacientes pediátricas con lesiones ováricas es heterogéneo, y en las niñas es conveniente conservar los ovarios. El objetivo de este estudio es analizar los hallazgos relacionados con un grupo de pacientes a las que se operó por lesiones ováricas. Pacientes y métodos. Un estudio retrospectivo realizado durante 13 años con 56 pacientes menores de 17 años. Estas pacientes se dividieron en 3 grupos según el diagnóstico de patología ovárica: 25 tenían lesiones funcionales (quistes y torsión), 18 tenían lesiones ováricas epiteliales y 13 tenían tumores germinales. Se comparó a estos tres grupos en términos de menarquia, torsión, edad, duración, tamaño, dolor, tumor, vómitos, menstruación irregular, ubicación y tipo de operación. Resultados. Enestosgrupos,fueronmásfrecuentes los quistes foliculares, los cistoadenomas serosos y los teratomas. La media de edad de las pacientes fue de 12,18 ± 4,84 años. Los síntomas y signos más frecuentes fueron dolor (85,7%) e hinchazón (37,5%) en la región abdominopélvica. Se observó torsión en 21 pacientes (37,5%); la media del tamaño del tumor fue de 10,46 ± 6,55 cm. Se realizó una salpingoovariectomía (SO, por sus siglas en inglés) en 38 pacientes y una resección del quiste (CE, por sus siglas en inglés) en 18 pacientes. Se observaron más casos de torsión en las pacientes premenárquicas que en las menárquicas y en el grupo de lesiones funcionales. Se realizaron más resecciones quirúrgicas en el grupo de lesiones funcionales, y más SO en los grupos de lesiones epiteliales y tumores germinales. Conclusión. Se considera que la torsión y las patologías ováricas funcionales son frecuentes en la edad premenstrual, y las lesiones malignas son muy raras en todos los grupos etarios, por lo que se recomienda preservar la fertilidad en la cirugía.

Introduction. The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions. Patients and methods. A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type. Results. Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18+4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46+6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups. Conclusion. Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.

Abdomen agudo quirúrgico en el embarazo / Abdômen cirúrgico agudo na gravidez / Acute surgical abdomen in pregnancy

Introducción: el abdomen agudo quirúrgico es una entidad que de no resolverse quirúrgicamente causa la muerte en la mayoría de los casos y, en la mujer embarazada, resulta de especial interés ya que los síntomas y signos no se presentan de una manera típica. Objetivo: caracterizar el comportamiento del abdomen agudo quirúrgico en embarazadas en el servicio de Ginecobstetricia del Hospital General Docente Octavio de la Concepción y de la Pedraja del municipio Baracoa, Guantánamo. Método: se realizó un estudio descriptivo transversal retrospectivo de 25 historias clínicas de pacientes embarazadas que presentaron un abdomen agudo quirúrgico en el período comprendido desde noviembre de 1996 hasta noviembre de 2005. Resultados: el grupo de 20-29 años de edad tuvo un 64 por ciento de frecuencia seguido del grupo de 15-19 años, con el 36 por ciento. La apendicitis fue la causa más frecuente de abdomen agudo quirúrgico con 10 casos, seguido de colecistitis aguda y quiste de ovario complicado, ambas con 5 pacientes. Esta entidad apareció en el 68 por ciento de las pacientes que cursaban su segundo trimestre de embarazo, seguido por las gestantes del tercer trimestre, con el 28 por ciento. Hubo síntomas de dolor abdominal y taquicardia en el 100 por ciento de los casos; náuseas en el 60 por ciento, y contractura y reacción peritoneal en el 80 por ciento. La urosepsis se notó como complicación en el 12 por ciento, sepsis de la herida quirúrgica en el 4 por ciento, para un índice de morbilidad del 20 por ciento, con un índice de mortalidad materna del 4 por ciento. Conclusiones: el abdomen agudo quirúrgico se presentó con una incidencia de 1,9 por cada 1 000 embarazadas y más frecuente en las edades entre 20-29 años. La apendicitis aguda, la colecistitis aguda y quiste de ovario complicado son las enfermedades que más se presentaron en el abdomen agudo quirúrgico durante el segundo trimestre del embarazo. Los síntomas más frecuentes fueron: dolor abdominal, contractura y reacción peritoneal. El mayor porcentaje de los casos resultó positivo en el diagnóstico clínico(AU)

Introduction: acute surgical abdomen is an entity that, if not resolved surgically, causes death in most cases and, in pregnant women, it is of special interest since the symptoms and signs do not appear in a typical manner. Objective: to characterize the behavior of acute surgical abdomen in pregnant women in the gynecology service of the General Teaching Hospital "Octavio de la Concepción y de la Pedraja" in the municipality of Baracoa, Guantánamo. Method: a retrospective cross-sectional descriptive study of 25 clinical histories of pregnant patients who presented an acute surgical abdomen in the period from November 1996 to November 2005. Results: the group of 20-29 years of age had 64 percent of frequency followed by the group of 15-19 years, with 36 percent. Appendicitis was the most frequent cause of acute surgical abdomen with 10 cases, followed by acute cholecystitis and complicated ovarian cyst, both with 5 patients. This entity appeared in 68 percent of the patients who were in their second trimester of pregnancy, followed by the pregnant women of the third trimester, with 28 percent. There were symptoms of abdominal pain and tachycardia in 100 percent of the cases; nausea in 60 percent, and contracture and peritoneal reaction in 80 percent. Urosepsis was noted as a complication in 12 percent, sepsis of the surgical wound in 4porcent, for a morbidity rate of 20 percent, with a maternal mortality rate of 4 percent. Conclusions: the acute surgical abdomen presented with an incidence of 1.9 per 1000 pregnant women and more frequent in the ages between 20-29 years. Acute appendicitis, acute cholecystitis and complicated ovarian cyst are the diseases that most occurred in the acute surgical abdomen during the second trimester of pregnancy. The most frequent symptoms were: abdominal pain, contracture and peritoneal reaction. The highest percentage of cases was positive in the clinical diagnosis(AU)

Introdução: o abdome cirúrgico agudo é uma entidade que, se não resolvida cirurgicamente, causa a morte na maioria dos casos e, em gestantes, é de especial interesse, uma vez que os sintomas e sinais não aparecem de maneira típica. Objetivo: caracterizar o comportamento do abdome cirúrgico agudo em gestantes do serviço de ginecologia do Hospital Universitário "Octavio de la Concepción y de la Pedraja" no município de Baracoa, Guantánamo. Método: estudo retrospectivo transversal, descritivo, com 25 histórias clínicas de gestantes que apresentaram abdome cirúrgico agudo no período de novembro de 1996 a novembro de 2005. Resultados: o grupo de 20-29 anos de idade apresentou 64 por cento de freqüência seguido pelo grupo de 15-19 anos, com 36 por cento. Apendicite foi a causa mais freqüente de abdome cirúrgico agudo com 10 casos, seguido de colecistite aguda e cisto ovariano complicado, ambos com 5 pacientes. Essa entidade apareceu em 68 por cento dos pacientes que estavam no segundo trimestre de gestação, seguidos pelas gestantes do terceiro trimestre, com 28 por cento. Houve sintomas de dor abdominal e taquicardia em 100 por cento dos casos; náusea em 60 por cento e contratura e reação peritoneal em 80 por cento. A urosepse foi notada como uma complicação em 12 por cento, sepse da ferida cirúrgica em 4 por cento, para uma taxa de morbidade de 20 por cento, com uma taxa de mortalidade materna de 4 por cento. Conclusões: o abdome cirúrgico agudo apresentou uma incidência de 1,9 por 1000 gestantes e mais frequente nas idades entre 20 a 29 anos. Apendicite aguda, colecistite aguda e cisto ovariano complicado são as doenças que mais ocorreram no abdome cirúrgico agudo durante o segundo trimestre da gravidez. Os sintomas mais frequentes foram: dor abdominal, contratura e reação peritoneal. O maior percentual de casos foi positivo no diagnóstico clínico(AU)

Primary pelvic hydatid cyst in a postmenopausal female: a surgical challenge

Primary pelvic hydatid cysts are a rare entity and are often overlooked as a differential diagnosis of a pelvic-space-occupying lesion particularly in non-endemic regions. Unpreparedness and a hasty decision on the surgical approach may end in life-threatening complications and systemic dissemination of the disease. We report the case of a 55-year-old postmenopausal woman with a history of two previous unsuccessful surgeries to remove pelvic cystic lesions due to dense adhesions between the surrounding gut wall, bladder, and the cyst wall. Clinical and imaging findings failed to diagnose the nature of the cysts, and a laparotomy was contemplated. On the third surgical attempt, the clinical suspicion was considered and by meticulous dissection the cysts were removed thoroughly without undue complications. In the postoperative follow-up period there was no sign of disease recurrence or dissemination.

Quiste de ovario intraligamentario gigante y miomatosis uterina / Giant intraligamentary ovary cyst and uterine myomatosis

Se presenta el caso de una paciente de 55 años de edad con quiste gigante de ovario. Fue atendida por integrantes de la Brigada Médica Cubana en la consulta de Ginecología del Hospital Regional de New Ámsterdam de la República de Guyana en el mes agosto de 2016 por presentar aumento de tamaño del abdomen, de aproximadamente dos años de evolución. El diagnóstico fue sospechado por ultrasonografía y tomografía axial computarizada. Se confirmó una tumoración quística gigante del ovario derecho a través de una laparotomía exploradora con dimensiones extraordinarias 48 cm de diámetro y peso 12,5 kg; además, miomatosis uterina. Se le realizó histerectomía total con doble anexectomía. El estudio histológico concluyó ser un cistoadenoma seroso de ovario y miomatosis uterina(AU)

We present the case of a 55-year-old female with giant ovarian cyst. She was attended in the gynecology consultation by members of the Cuban Medical Brigade, at the Regional Hospital of New Amsterdam in the Republic of Guyana during August, 2016. She presented a size increase abdomen, of approximately two years of evolution. The diagnosis was suspected by ultrasonography and computerized axial tomography. An exploratory laparotomy confirmed a giant cystic tumor in the right ovary of extraordinary dimensions (48 cm in diameter and 12.5 kg in weight), beside uterine myomatosis. A total hysterectomy was performed with double annexectomy. The histological study concluded that it was a serous cystadenoma of ovary and uterine myomatosis(AU)

Rocuronium and sugammadex in a 3 days old neonate for draining an ovarian cyst. Neuromuscular management and review of the literature / Rocurônio e sugamadex em recém-nascido de 3 dias para drenagem de um cisto ovariano. Controle neuromuscular e revisão da literatura

Abstract A case is reported in which a 3-days old neonate with a giant ovarian cyst was scheduled for surgery. The patient received a dose of sugammadex to reverse a rocuronium-induced neuromuscular block. A fast and efficient recovery from neuromuscular block was achieved within 90 s. No adverse events or other safety concerns were observed. Furthermore, a review of the literature on the use of sugammadex in neonates was performed.

Resumo Relato do caso de uma criança recém-nascida de três dias de idade com um cisto ovariano gigante programada para a cirurgia. A paciente recebeu uma dose de sugamadex para reverter o bloqueio neuromuscular induzido por rocurônio. Uma recuperação rápida e eficiente do bloqueio neuromuscular foi obtida dentro de 90 segundos. Não foram observados efeitos adversos ou outros problemas de segurança. Além disso, uma revisão da literatura sobre o uso de sugamadex em recém-nascidos foi feita.

Meningocele sacro anterior que simula quiste de ovario tabicado / Anterior sacral meningocele simulating ovarian cyst baffled

El meningocele sacro anterior es una rara anomalía genética asociada a enfermedades del tejido conectivo como el síndrome de Marfán, síndrome de Loeys-Dietz, la neurofibromatosis tipo 1 y otras. El objetivo del presente trabajo es presentar el caso de un feto con meningocele sacro anterior, inicialmente diagnosticado como un gran quiste de ovario multilobulado, en una paciente con diagnóstico de síndrome de Marfan. Se trata de una herniación del saco dural, a través de agujeros sacros amplios y deformados por ectasia dural, ocupada mayormente por líquido cefalorraquídeo. La punción de estas estructuras o su rotura en el acto operatorio se ha asociado a complicaciones graves e incluso la muerte(AU)

The anterior sacral meningocele is a rare genetic anomaly associated with connective tissue diseases such as Marfan syndrome, Loeys-Dietz syndrome, neurofibromatosis type 1 and others. The aim of this paper is to present the case of a fetus with anterior sacral meningocele, initially diagnosed as a large multilobulated ovarian cyst in a patient diagnosed with Marfan syndrome It is a herniation of the dural sac, through large sacral foramina, and deformed by dural ectasia, occupying mostly by cerebrospinal fluid. Puncture or rupture these structures during surgery has been associated with serious complications and even death(AU)

Dilemma in the Management of Ovarian Cyst in Pregnancy: A Series of Three Different Cases.

The incidence of ovarian cyst in pregnancy is increased due to ovulation induction and dating ultrasound. Mostly they are benign and managed by observation. Surgery is indicated if there are complications or any suspicion of malignancy. Here, we have presented three different cases of ovarian cyst in pregnancy, which was managed by surgery. The first case is a 27-year-old second gravida with para1 live1 with complaints of pain in right iliac fossa at 15 weeks of gestation that was diagnosed as a dermoid cyst of right ovary. She underwent laparoscopic cystectomy. Rest of the antenatal period was uneventful, and she delivered vaginally at term. The second case is 31 year old third gravida with para2 live2 came with complaints of lower abdominal pain around 14 weeks of gestation which was diagnosed as fibroma of ovary for which laparotomy and right salphingo-oophorectomy was done. Rest of the antenatal period was normal, she delivered by caesarean section at term. The third case was 30-year-old second gravid with para1 live1 with left ovarian mass presented at term for which cesarean section along with left salphingo-oophorectomy done.

Laparoscopic ovarian ligament plication in pregnancy / Plicatura laparoscópica del ligamento ovárico en el embarazo

This 32-year old patient presented at seven weeks gestation with severe left-sided lower abdominal pain. This was against the background of a previous history of left salpingectomy from a ruptured ectopic gestation seven years previously. Transvaginal sonographic evaluation revealed a viable seven week intrauterine embryo, a 2 cm left corpus luteum cyst and Doppler studies revealed reduced internal flow. This led the way for a conservative approach via laparoscopy of untwisting the pedicle to restore blood flow. In this case, the ovarian ligament was shorted using 1/0 vicryl and the pregnancy went to term.

Esta paciente de 32 años se presentó en la séptima semana de gestación con un severo dolor abdominal en el lado inferior izquierdo. Esto ocuría teniendo la paciente por antecedente una historia previa de salpingectomía izquierda a partir de la ruptura de un embarazo ectópico siete años antes. La evaluación sonográfica transvaginal reveló un embrión intrauterino viable de siete semanas, un quiste del 2 cm en el cuerpo lúteo izquierdo, y los estudios de Doppler revelaron un flujo interno reducido. Esto abrió el camino para un abordaje conservador vía laparoscopia encaminada a deshacer la torsión del pedículo y restablecer así el flujo sanguíneo. En este caso, el ligamento ovárico fue acortado usando vicryl 1/0, y el embarazo continuó a término.

Quiste ovárico fetal: diagnóstico prenatal y manejo quirúrgico postnatal exitoso / Prenatal diagnosis of fetal ovarian cyst

Los quistes ováricos son el tumor abdominal mas frecuente en las recién nacidas. Presentan complicadones agudas y a largo plazo. La más frecuente es la torsión anexial que presenta dificultades diagnósticas en la etapa neonatal. El diagnóstico prenatal es fundamental para el manejo oportuno de las pacientes. Existen diferentes alternativas terapéuticas donde la cirugía mínimamente invasiva y conservadora juega un importante rol. Presentamos el caso de una recién nacida macrosómica con diagnóstico prenatal de quiste ovárico no complicado que sufrió torsión durante los primeros días de vida y se resolvió exitosamente en forma quirúrgica conservadora gracias a un manejo multidisciplinario.

Ovarian cysts are the most common abdominal tumor in female newborns. They could develop acute or long term complications. The most frequent complication is adnexal torsion, which presents with diagnostic difficulties in the neonatal period. Prenatal diagnosis is essential for the prompt management of patients. There are different treatment options where conservative and minimally invasive surgery plays an important role. We report a female newborn with prenatal diagnosis of macrosomia and uncomplicated ovarian cyst, which suffered adnexal torsion during the first days of life and was successfully resolved with a conservative surgical management by a multidisciplinary staff.

Adenexal cysts;survey of ultrasonography, preoperative findings, histopathology

[1] To evaluate the risk of malignancy in surgically removed ovarian cysts that was before the operation neither simple nor complex. [2] To determine the relationship of age with type of ovarian tumour. [3] To categorize the management of these cases according to the intra-operative findings. [4] To analyze the occurrence of various histopathological types of tumour. Medline Study Single centered prospective descriptive study of 150 cases. Department of Obstetrics and Gynaecology at Shaikh Zayed Hospital Lahore from 1st July 2005 to, 31st December 2006. 150 patients presented with adnexal cysts on preoperative ultrasonography, peroperative findings and histopathology reports. These patients were followed up in OPD. Showed the distribution of non-neoplastic and neoplastic tumours which were 84% and 16% respectively. The occurrence of malignancy increased with advancing age especially after 45 years Common presentations were lower abdominal pain [53%] followed by menstrual disturbances [30%], abdominopelvic mass, abdominal distension and infertility. Risk of malignancy also increased with parity. 73% masses were unilateral, 84% benign masses were unilocular whilst 85% malignant masses were echogenic and the complex cysts with papillary projection and multiloculations showed 3-6 times higher risk of malignancy. Most patients were managed by exploratory laparotomy. Cystectomy and total abdominal hysterectomy were the commonest procedures performed. Regarding histopathologic evaluation 40% patients had tumours, 2.66% borderline malignancy and 13.3% malignant. 44% had non-neoplastic lesions. Serous and endometriotic cysts were the commonest benign histopathologic types and among malignant ones, epithelial ovarian tumours were the leading variants. Preoperative characterization of adnexal masses using sonographic and demographic data may have considerable potential in determining risk of malignancy and may be advantageous in terms of counseling patients for management

Operative laparoscopy in pregnancy for a large paraovarian cyst

The use of operative laparoscopy for paraovarian cysts in pregnancy is relatively new. A 26-year-old primigravida at 20 weeks of gestation was discovered to have a 20 x 15-cm adnexal cyst during ultrasound. Laparoscopic excision of the 20 x 15-cm paraovarian cyst after aspiration of 2.5 L of fluids was performed without complications. The operative time was 60 minutes. The patient was released from the hospital less than 24 hours after surgery in good general condition. Follow-up in the outpatient clinic was satisfactory. The final histopathology confirmed the 20 x 15-cm paraovarian cyst. The patient delivered vaginally and spontaneously at term. Operative laparoscopy may be safe for removing large paraovarian cysts during pregnancy

Minimally invasive trans-umbilical laparotomy in neonatal ovarian cysts

In 1986, Tan and Bianchi reported that the umbilical incision could be used for pyloromyotomy in infantile hypertrophic pyloric stenosis. Since then, many pediatric surgeons have used this approach for a number of other procedures. This work is an attempt to ascertain the feasibility of trans-umbilical incision in the management of neonatal ovarian cysts. From January 2008 to January 2011, 5 female newborns with ovarian cysts were treated via the trans-umbilical route. Indications for surgery were symptomatic simple cyst, cysts more than 5 cm. in diameter and complex cyst diagnosed by ultrasound. All patients were treated with a semicircular infra-umbilical incision. The wall of the cyst was grasped by forceps or sucked by a suction tube then the content was aspirated and the partially collapsed cyst was then delivered through the incision easily. Cystectomy with ovarian tissue sparing was performed outside the abdominal wall in all cases. All the patients were followed for at least 6 month post-operatively. The cysts were simple in 4 cases, and complex in one case. The average size was 9.7 cm. [ranged 7.2-12.5 cm.] for the simple cysts and 6.6 cm. for the complex cyst. The average age at operation was 13 days [ranged 2-25 days]. The mean operating time was 25.4 minutes [ranged 30 - 45 minutes]. All patients were discharged 24 hours after operation with uneventful post operative course. The scars were hardly detectable about 2 weeks later. All the patients were followed for at least 6 month post-operatively without complications. My experience has shown that the umbilical incision is an excellent, safe, and versatile alternative to laparoscopy or other open abdominal incisions for the treatment of neonatal ovarian cysts with even more better cosmetic results

Quiste de ovario errante / Erratic ovarian cyst

Se presenta el caso de un paciente de 52 años de edad, que ingresó en el Centro Nacional de Cirugía Endoscópica a causa de un dolor constante y sensación de pesadez en el bajo vientre, además de trastornos dispépticos. Después de los estudios de laboratorio e imaginológicos se diagnosticó un quiste de ovario derecho de 5-8 cm y varios cálculos menores de 10 mm en la vesícula biliar. Durante la intervención quirúrgica se encontró un quiste (ecolúcido), necrosado, adherido al mesocolon e independiente del ovario. Se practicó su exéresis y una colecistectomía. Por resultar una localización infrecuente de un quiste de ovario, se decide exponer las características clínicas y los resultados quirúrgicos y anatomopatológicos de este caso a la comunidad científica nacional e internacional. Se hace referencia además a la posibilidad que brindó el acceso por cirugía laparoscópica de realizar procedimientos asociados en un mismo paciente: colecistectomía y exéresis del quiste de ovario errante(AU)

The case of a female patient aged 52 is presented, admitted in the National Endoscopy Surgery Center due to a persistent pain and heaviness sensation in the lower stomach as well as dyspeptic disorders. After laboratory and imaging studies a cyst in right ovary of 5-8 mm diameter (echolucid), necrotic and adhered to mesocolon was diagnosed. A exeresis and a cholecystectomy were performed. Due to its infrequent location of a ovarian cyst the clinical features and the surgical and anatomical and pathological results are presented to national and international scientific community. Authors also make reference to the possibility allowed by the laparoscopic surgery approach to carry out procedures associated in a same patient: cholecystectomy and exeresis of erratic ovarian cyst(AU)

Tuberculosis peritoneal en una adulta joven / Peritoneal tuberculosis in a young adult

Se describe el caso clínico de una paciente desnutrida de la República de Djibouti, de 24 años de edad y procedencia rural, atendida en el Servicio de Urgencia de Cirugía por presentar dolor en hipogastrio, fijo, mantenido y punzante, que se intensificaba progresivamente, además de náuseas y vómitos biliosos. En la exploración bimanual se palpó una masa anexial en el lado derecho, muy dolorosa, de casi 8 cm. Los exámenes realizados confirmaron la presencia de un quiste de ovario torcido y posible tuberculosis peritoneal, lo cual se comprobó con el diagnóstico peroperatorio. La joven evolucionó satisfactoriamente y fue trasladada al Servicio de Medicina para tratamiento antibacilar.

The clinical case of a undernourished 24-year-old patient of the Republic of Djibouti who lived in a rural region is described. She was attended in the Emergency Department of Surgery due to a fixed, continuous and stabbing hypogastric pain, which was intensified progressively besides nauseas and bilious vomiting. A very painful adnexal mass of almost 8 cm was palpated in the right side with a bimanual exploration. Examinations confirmed the presence of a bent ovaric cyst and a possible peritoneal tuberculosis, which was proven with intraoperative diagnosis. She made a good progress and was transferred to the Medicine Service for antibacillary treatment.

Massas anexiais na gestação / Adnexal masses in pregnancy

O advento da ultrassonografia (US) durante o pré-natal tem contribuído para o aumento da detecção de massas anexiais na gestação. A maior parte dos tumores tem resolução espontânea por volta da 16ª semana de gestação, sendo associada a cistos funcionais. Massas que persistem após esse período podem acarretar riscos de torção, ruptura e obstrução do canal de parto, necessitando, muitas vezes, de uma intervenção cirúrgica de emergência. A ocorrência de tumores malignos é rara. Além da US, que é utilizada como primeira modalidade para o diagnóstico, o estudo do CA-125 e do B-hCG deve ser realizado. Esses marcadores estão normalmente aumentados durante a gestação. No entanto, na presença de massas tumorais, os níveis são bem mais alterados. O manejo dessa patologia na gravidez é desafiante para o médico e acarreta ansiedade para a paciente. A cirurgia, quando indicada, deverá ser realizada entre o segundo e terceiro trimestres da gestação, levando-se em conta os riscos de complicações para a mãe e o feto. Estudos mostram que, havendo indicações precisas de tratamento adjuvante na gravidez, seu uso não deve ser adiado, pois, em longo prazo, o prognóstico para fetos expostos à quimioterapia intra-útero parece ser bom.

The advent of routine prenatal ultrasonography (US) has increased the detection of adnexal masses during pregnancy. The majority of tumors spontaneously resolve around the 16ª week of gestation, usually being associated with functional cysts. Masses that last after this period can complicate on risks of torsion, rupture of obstruction of labor, requiring emergent surgical intervention. The prevalence of malignant tumor is rare. Besides the use of US, which is the primary diagnostic modality, the study of tumor markers, such as CA-125 and B-hCG, must be done. Their levels are already elevated during pregnancy. However, in the presence of certain types of tumors, these levels are much more altered. The management of this pathology during pregnancy is quite challenging to the medical team and involves psychological issues to the patient. When indicated, the surgery must be taken place between the second and third trimester, always considering the risks of complications to the mother and the fetus. Several studies report that if there are strong indications for adjuvant therapy, it should not be delayed, because the longterm fetal outcomes appear to be good for those fetuses exposed to chemotherapy in utero.

Quiste Gigante de Ovario: presentación de un caso / Giant ovarian cyst: a case report

Se presenta un caso de quiste gigante del ovario, en una adolescente de 19 años de edad, que fuera atendida por el Servicio de Ginecología del Hospital Universitario de La Paz de Puerto Príncipe en Haití, en el año 2006, por un aumento de tamaño en el abdomen además de presentar una amenorrea de 6 meses de evolución en una paciente que había tenido menstruaciones regulares desde lo 12 años que tubo su menarquía. Se realizaron estudios clínicos y ultrasonográficos. Se confirma a través de una laparotomía exploradora, una tumoración quística gigante del ovario con dimensiones extraordinarias, lo que es poco frecuente. En su estudio anatomopatológico se comprobó el diagnóstico de cistoadenoma seroso del ovario.

A case of giant avarian cyst is presented in a 19 year old teenager that was assisted by the Gynaecology Sevice at the University Hospital of La Paz of Port-au-Prince in Haiti, in 2006 due to an increase of the size of the abdomen apart from presenting an amenorrhea of 6 months of evolution in a patient that had had regular menstruations since she had her menarche at 12 years old. Clinical and ultrasound-graphical studies were done. A giant ovarian tumorous cyst with extraordinary dimension, which is not frequent, was confirmed by means of an exploratory laparascopy. In an anatomopathological study, the diagnosis of serous cystadenoma of the ovary was corroborated.