Document Detail

The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child.
Jump to Full Text
MedLine Citation:
PMID:  23119216     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Ibrahim Uygun; Bahattin Aydogdu; Mehmet Hanifi Okur; Selcuk Otcu
Related Documents :
22731866 - Intracranial mesenchymal chondrosarcoma: case report and literature review.
9397546 - Violent behaviors associated with the antichrist delusion.
23312586 - Fatal falls from bicycles: a case report.
22613806 - Polyps originating from accessory middle turbinate and secondary middle turbinate.
2063996 - Giant somatosensory evoked potentials in the rett syndrome.
10651706 - Two cases of primary hyperparathyroidism associated with primary cutaneous lymphoma.
Publication Detail:
Type:  Journal Article     Date:  2012-10-15
Journal Detail:
Title:  Case reports in surgery     Volume:  2012     ISSN:  2090-6919     ISO Abbreviation:  Case Rep Surg     Publication Date:  2012  
Date Detail:
Created Date:  2012-11-02     Completed Date:  2012-11-05     Revised Date:  2013-03-14    
Medline Journal Info:
Nlm Unique ID:  101580191     Medline TA:  Case Rep Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  615734     Citation Subset:  -    
Affiliation:
Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Case Rep Surg
Journal ID (iso-abbrev): Case Rep Surg
Journal ID (publisher-id): CRIM.SURGERY
ISSN: 2090-6900
ISSN: 2090-6919
Publisher: Hindawi Publishing Corporation
Article Information
Download PDF
Copyright © 2012 Ibrahim Uygun et al.
open-access:
Received Day: 28 Month: 7 Year: 2012
Accepted Day: 18 Month: 9 Year: 2012
Print publication date: Year: 2012
Electronic publication date: Day: 15 Month: 10 Year: 2012
Volume: 2012E-location ID: 615734
PubMed Id: 23119216
ID: 3478731
DOI: 10.1155/2012/615734

The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child
Ibrahim Uygun*
Bahattin Aydogdu
Mehmet Hanifi Okur
Selcuk Otcu
Department of Pediatric Surgery and Pediatric Urology, Medical Faculty of Dicle University, 21280 Diyarbakir, Turkey
Correspondence: *Ibrahim Uygun: iuygun@hotmail.com
[other] Academic Editors: M. Gorlitzer and R. Mofidi

1. Introduction

An autoamputated ovary (AO) is a very rare cause of an intraabdominal mass [125]. The primary pathological event of an AO is torsion of a normal ovary or an ovarian cyst and the adnexa, followed by infarction and necrosis [17, 21, 26, 27]. Typically, the AO is found incidentally while investigating an unrelated disease, on antenatal ultrasonography, or at surgery [125].

Here, we present a patient who underwent surgery for an acute abdomen and was observed to have a free-floating AO in the abdominal cavity. We also review the occurrence of this extremely rare free-floating mass in children and discuss its diagnosis and management.


2. Case Presentation

A 4-year-old girl was admitted with nausea, vomiting, and abdominal pain. On physical examination, the right lower abdominal quadrant was tender. Abdominal guarding and rebound were detected. The abdominal plain X-ray was normal. Emergency ultrasonography (US) showed minimal free fluid. The patient underwent surgery for an acute abdomen. At surgery, a 28 mm diameter, brown, soft, calcified mass was found floating in the right lower abdomen (Figure 1). The patient had no right ovary and the right tube ended in a thin band that extended to the cecum and pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen (Figure 2). The appendix was hyperemic. The free-floating mass was removed from the abdomen, the right fallopian tube and band were excised, and an appendectomy was performed. The patient was discharged on the second postoperative day. The pathological examination showed long standing necrotic tissue debris with calcifications. The 6-year follow up showed no problems.


3. Discussion

A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. To date, there have been only two cases in the literature that originated from other organs [28, 29]; one such mass in a geriatric woman was from the gallbladder, due to torsion, and caused acute abdomen, while the other was from appendix epiploica, due to torsion, in a man [28, 29]. A free-floating intraperitoneal AO in a child was first reported by Lester and McAlister in 1970 [1]. Our case is the first report of an intraperitoneal free-floating mass causing an acute abdomen in a child.

There have been only 36 reported cases of intraperitoneal free-floating AO involving children ranging in age from 1 day to 12 years of age, including our case (Table 1) [125]. Twenty-five cases were younger than 1 year of age. Although 23 of these infants were diagnosed with a cystic abdominal mass, ranging in diameter from 2.2 to 8 cm on antenatal US, only 12 of the newborns were operated on during the neonatal period.

Six cases were symptomatic, including our case. One of the newborns had abdominal distention, intestinal obstruction, and respiratory distress syndrome due to an 8 cm diameter cyst [24]. Four children, ages 14 and 17 months, 2 years, and 12 years, had a history of abdominal pain without an acute abdomen and were diagnosed during routine physical examinations [1, 3, 7]. Only our 4-year-old patient developed an acute abdomen, with signs and symptoms that included tenderness in the right abdominal quadrant, nausea, and vomiting.

Nine of the masses could be palpated on physical examination. Only three cases were diagnosed as an AO preoperatively. Characteristically, an AO is seen as a free-floating intraabdominal mass on antenatal US [13, 19, 25]. Eight cases were diagnosed incidentally. Two had no abdominal pain but were diagnosed based on palpating an abdominal mass during a routine physical examination [3]. The other six patients were diagnosed with a calcified mass seen on plain X-rays obtained for an unrelated reason [2, 3, 6, 10, 12]. The AO was the right ovary in 17 cases, the left in 11, bilateral in two, and unknown in six cases.

Ultrasonography is safe and sufficient for diagnosing most ovarian cysts and AO. Computed tomography and magnetic resonance imaging may be performed if the mass is complex [22]. In our case, emergency US showed minimal free fluid, but no AO, perhaps because our patient had an intestinal obstruction and a dilated intestine with intraluminal gas. A plain X-ray may also be sufficient, especially with a calcified AO [13, 5, 7, 10]. In the literature, 25 of 36 cases of AO were diagnosed prenatally with antenatal US. We believe that this is because antenatal US is performed very commonly worldwide.

Pathologically, necrosis was seen in all cases, and 20 had calcifications. Small amounts of ovarian tissue were seen in seven specimens [3, 7, 18, 20, 23, 25]. In four of these cases, the AO was attached to the retroperitoneum and ascending colon by vessels [3], the omentum [23], the mesentery of the transverse colon via a long pedicle [7], or to the liver via a hemorrhagic twisted pedicle of omentum [7]. None contained malignant tissue. In adults, Ushakov et al. reported a remarkable characteristic of AO: an AO teratoma became reimplanted as an omental mass in 22 cases of teratoma of the omentum that they reviewed [26]. This adult review and our review of children suggest that an AO may reimplant, develop into omentum or peritoneum, and possibly undergo malignant transformation. Therefore, we suggest that all AOs should be excised instead of taking a wait and see approach.

An AO is very rare and thought to result from ovarian torsion. Most free-floating AOs are detected incidentally. However, clinicians should remember that it can cause an acute abdomen, and should always make sure there are two ovaries on US in a small child with acute abdomen.


Conflict of Interests

The authors declare that there is no conflict of interests.


References
1. Lester PD,McAlister WH. A mobile calcified spontaneously amputated ovaryJournal of the Canadian Association of RadiologistsYear: 19702131431452-s2.0-00148448155479486
2. Nixon GW,Condon VR. Amputated ovary: a cause of migratory abdominal calcificationAmerican Journal of RoentgenologyYear: 19771286105310552-s2.0-0017403455414543
3. Kennedy LA,Pinckney LE,Currarino G,Votteler TP. Amputated calcified ovaries in childrenRadiologyYear: 1981141183862-s2.0-00193878417291547
4. Avni EF,Godart S,Israel C,Schmitz C. Ovarian torsion cyst presenting as a wandering tumor in a newborn: antenatal diagnosis and post natal assessmentPediatric RadiologyYear: 19831331691712-s2.0-00206412766866578
5. Alrabeeah A,Galliani CA,Giacomantonio M,Heifetz SA,Lau H. Neonatal ovarian torsion: report of three cases and review of the literaturePediatric PathologyYear: 1988821431492-s2.0-00237485143045782
6. Fletcher RM,Boal DKB,Karl SR,Gross GW. Ovarian torsion: an unusual case of bilateral pelvic calcificationsPediatric RadiologyYear: 19881821721732-s2.0-00238793053353153
7. Currarino G,Rutledge JC. Ovarian torsion and amputation resulting in partially calcified, pedunculated cystic massPediatric RadiologyYear: 1989196-73953992-s2.0-00243830442771477
8. Mordehai J,Mares AJ,Barki Y,Finaly R,Meizner I. Torsion of uterine adnexa in neonates and children: a report of 20 casesJournal of Pediatric SurgeryYear: 19912610119511992-s2.0-00260665541779328
9. Brandt ML,Luks FI,Filiatrault D,Garel L,Desjardins JG,Youssef S. Surgical indications in antenatally diagnosed ovarian cystsJournal of Pediatric SurgeryYear: 19912632762822-s2.0-00260322571827651
10. Ledesma-Medina J,Towbin RB,Newman B. Pediatric case of the day. Right ovarian torsion, amputation, and calcification.RadiographicsYear: 19921211992002-s2.0-00264715131734472
11. Aslam A,Wong C,Haworth JM,Noblett HR. Autoamputation of ovarian cyst in an infantJournal of Pediatric SurgeryYear: 19953011160916102-s2.0-00287994738583338
12. Keshtgar AS,Turnock RR. Wandering calcified ovary in childrenPediatric Surgery InternationalYear: 1997122-32152162-s2.0-0030888291
13. Jawad AJ,Zaghmout O,Al-Muzrakchi AD,Al-Hammadi T. Laparoscopic removal of an autoamputated ovarian cyst in an infantPediatric Surgery InternationalYear: 1998132-31951962-s2.0-00318918299563048
14. Esposito C,Garipoli V,Di Matteo G,De Pasquale M. Laparoscopic management of ovarian cysts in newbornsSurgical EndoscopyYear: 1998129115211542-s2.0-00321601909716771
15. Decker PA,Chammas J,Sato TT. Laparoscopic diagnosis and management of ovarian torsion in the newborn.Journal of the Society of Laparoendoscopic SurgeonsYear: 1999321411432-s2.0-003310960510444015
16. Corbett HJ,Lamont GA. Bilateral ovarian autoamputation in an infantJournal of Pediatric SurgeryYear: 2002379135913602-s2.0-003672546112194134
17. Tseng D,Curran TJ,Silen ML. Minimally invasive management of the prenatally torsed ovarian cystJournal of Pediatric SurgeryYear: 20023710146714692-s2.0-003678900512378456
18. Tsobanidou C,Dermitzakis G. Ovarian cyst as a pelvic mass in an infantEuropean Journal of Gynaecological OncologyYear: 20032465825832-s2.0-034487602114658611
19. Visnjic S,Domljan M,Zupancic B. Two-port laparoscopic management of an autoamputated ovarian cyst in a newbornJournal of Minimally Invasive GynecologyYear: 20081533663692-s2.0-4224909918618439514
20. Herrera RJH,Sanchez LFR,Flores RC,Acuna Reyes JR,Carmona Martínez G. Prenatal diagnosis ovarian cyst with an amputation at three months of age: a case reportGinecologia y Obstetricia de MexicoYear: 200977837237519902627
21. Koike Y,Inoue M,Uchida K,et al. Ovarian autoamputation in a neonate: a case report with literature reviewPediatric Surgery InternationalYear: 20092576556582-s2.0-6765076252219513725
22. Zampieri N,Scirè G,Zamboni C,Ottolenghi A,Camoglio FS. Unusual presentation of antenatal ovarian torsion: free-floating abdominal cysts. Our experience and surgical managementJournal of Laparoendoscopic and Advanced Surgical TechniquesYear: 2009191S149S1522-s2.0-6534911540918973466
23. Amodio J,Hannao A,Rudman E,Banfro F,Garrow E. Complex left fetal ovarian cyst with subsequent autoamputation and migration into the right lower quadrant in a neonate: case report and review of the literatureJournal of Ultrasound in MedicineYear: 20102934975002-s2.0-7794986701820194948
24. Marinkovic S,Jokic R,Bukarica S,Mikic AN,Vuckovic N,Antic J. Surgical treatment of neonatal ovarian cystsMedicinski PregledYear: 2011647-840841221970071
25. Kuwata T,Matsubara S,Maeda K. Autoamputation of fetal/neonatal ovarian tumor suspected by a "side change" of the tumorJournal of Reproductive Medicine for the Obstetrician and GynecologistYear: 2011561-291922-s2.0-7995156439921366137
26. Ushakov FB,Meirow D,Prus D,Libson E,BenShushan A,Rojansky N. Parasitic ovarian dermoid tumor of the omentum-a review of the literature and report of two new casesEuropean Journal of Obstetrics Gynecology and Reproductive BiologyYear: 199881177822-s2.0-0032190487
27. Schmahmann S,Haller JO. Neonatal ovarian cysts: pathogenesis, diagnosis and managementPediatric RadiologyYear: 19972721011052-s2.0-00310402919028838
28. Laso FJ,Procel C,Pastor I,Vásquez G,Ramos RM. Gallbladder torsion: report of a caseAnales de Medicina InternaYear: 1989631491502-s2.0-00246296942491191
29. Murat FJL,Gettman MT. Free-floating organized fat necrosis: rare presentation of pelvic mass managed with laparoscopic techniquesUrologyYear: 20046311761772-s2.0-074227216914751387

Article Categories:
  • Case Report


Previous Document:  Radioiodine accumulation in a giant ovarian cystadenofibroma detected incidentally by 131-I whole bo...
Next Document:  A mucinous cystic neoplasm of the mesocolon showing features of malignancy.