A 35-day-old female infant presented with incessant cry and with an antenatal diagnosis of ovarian cyst. On evaluation and laparotomy, she was found to have a huge ovarian cyst with torsion and gangrene, which was excised successfully. This is being presented to highlight the possibility of early torsion and gangrene with antenatally detected ovarian cysts and the successful management of one such case.

1. Neonatal ovarian cyst with torsion

2. Apollo Medicine 2011 December
Case Report
Volume 8, Number 4; pp. 313–314
© 2011, Indraprastha Medical Corporation Ltd
Neonatal ovarian cyst with torsion
C Vijay Anand*, Kumar Venkatesan**
*Department of Paediatric Surgery, **Consultant Paediatric Surgeon, Apollo Speciality Hospitals, Madurai – 625020, India.
ABSTRACT
A 35-day-old female infant presented with incessant cry and with an antenatal diagnosis of ovarian cyst. On evalua-
tion and laparotomy, she was found to have a huge ovarian cyst with torsion and gangrene, which was excised suc-
cessfully. This is being presented to highlight the possibility of early torsion and gangrene with antenatally detected
ovarian cysts and the successful management of one such case.
Keywords: Gangrene, neonatal ovarian cyst, torsion
Correspondence: Dr. Kumar Venkatesan, E-mail: info@karthikhospitalmadurai.com
doi: 10.1016/S0976-0016(11)60017-3
INTRODUCTION
Although ovarian cysts are the most common cysts in the
female neonates, nowadays with routine availability of qual-
ity antenatal ultrasound, increasing number of cases is being
detected. Most of the simple cysts usually regress within
6 months of life.1
But still, there exists a therapeutic dilemma
regarding the management of complex ovarian cysts with
some reports advocating conservative treatment and observa-
tion for them too.2
Here, we are presenting a child who was
antenatally diagnosed to have an ovarian cyst and presented
to us by 35 days of life with torsion.
CASE HISTORY
A 35-day-old infant was referred for incessant cry with an
antenatal diagnosis of the intra-abdominal cyst. The child
had a history of swelling/fullness in the right side of the
abdomen since birth. On examination, it was a soft mobile
swelling of size about 4×3 inches, cystic in nature present
predominantly over the right iliac fossa. Blood investiga-
tions were within normal limit. Sonogram and computed
tomography abdomen done revealed a complex multi-
septate ovarian cyst.
The child was taken up for laparotomy and found to have
an ovarian cyst arising from the left ovary with torsion and
gangrene. The other ovary was normal. Left oophorectomy
was done. The child recovered well and the postoperative
period was uneventful.
DISCUSSION
Several theories have been postulated for the genesis of ovar-
ian cysts. Fetal exposure to maternal and fetal gonadotropins,
mothers with elevated levels of beta-human chorionic gona-
dotropin (β-hCG) precocious follicle-stimulating hormone
(FSH) peak between 20 and 30 weeks of gestation, abnormal
hCG peaks due to disorders of theca interna, prematurity, and
fetal hypothyroidism are all proposed to be the possible etiol-
ogy of congenital ovarian cysts.3
Some studies also postulate
that the formation of the cyst and torsion is all secondary to
the germinal epithelial secretions from a dysgenetic gonad.2
With good quality antenatal sonograms, the detection
rate is quite high now and up to 34% if the fetuses may
have sonographically detected cysts antenatally.4
More than
30% of these cysts regress within the first 6 months of life,
although regression in certain cases may take up to 10 months.
Regression is possibly because of the negative biofeedback
mechanism of the anterior pituitary, which discontinues the
abnormal gonadotropin secretion.
Nussbaum’s classification of neonatal cysts classifies
these ovarian cysts into simple or uncomplicated and compli-
cated cysts with fluid debris level, septae and echogenic wall,
suggesting torsion.4
Untreated cysts can go for complications

3. 314 Apollo Medicine 2011 December; Vol. 8, No. 4 Anand and Venkatesan
© 2011, Indraprastha Medical Corporation Ltd
such as hemorrhage, rupture, torsion and malignancy. Among
these, torsion is the most common complication contributing
to 50–78% of the complications, as the newborn has a long
pedicle and can occur quite early and also possibly antenatally.5
Hence, in conclusion, simple cysts shall be observed and
complex or larger cysts, usually >4cm diameter,6
need surgi-
cal correction, since torsion can occur early, as in our case.
REFERENCES
1. Singhal AK, Vignesh KG, Paul S, Matthai J. Antenatally
diagnoses ovarian cyst with torsion managed laparoscopically.
J Indian Assoc Pediatr Surg 2008;13:28–9.
2. Enriquez G, Duran C, Toran N, et al. Conservative versus sur-
gical treatment for complex neonatal ovarian cysts: outcomes
study. Am J Roentgenol 2005;185:501–8.
3. Chiaramonte C, Piscopo A, Cataliotti F. Ovarian cysts in new-
borns. Pediatr Surg Int 2001;17:171–4.
4. Nussbaum AR, Sanders RC, Hartman JS, Dudgeon DL,
Parmley TH. Neonatal ovarian cyst: sonographic pathologic
correlation. Radiology 1988;168:817–21.
5. Jaferi SZ, Bree RL, Silver TM, Quimette M. Fetal ovarian
cysts: sonographic detection and association and hypothy-
roidism. Radiology 1984;150:809–12.
6. Alrabeeah A, Galliani C, Giacomantonio M, Heifetz SA,
Lau H. Neonatal ovarian torsion: report of 3 cases and review
of literature. Fetal Pediatr Pathol 1988;8:143–9.
A B
C D
Figure 1 (A) Cyst being delivered out, (B, C) cyst with torsion and gangrene, and (D) specimen—gangrenous cyst after resection.

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