Prenatal ovarian torsion: Diagnosis and management in the newborn

Abstract

Introduction: Prenatal ovarian torsion (POT) is a clinical condition that has been described before, but is little known and up until now lacks clear guidelines on management. Prenatal discovery of an abdominal mass or cyst can lead to a lot of stress and anxiety with parents. Knowing that POT is a benign condition with marked sonographic-pathologic correlations, our aim is to define the clinical entity and radiological features of a POT with the largest population to date and set up clear guidelines on its management. Materials and methods: We retrospectively collected data from three different pediatric surgical units over a period of 10 years (between 2008-2018). All patients treated for POT were included. Postnatal radiological imaging as well as clinicopathological information was collected and correlated with our diagnostic criteria. Results: We recovered data from a total of 35 patients. A fluid-debris level on ultrasonography (US) was shown to be a specific feature of torsion and was present in all patients. All patients underwent laparoscopic resection of the cyst at a mean age of 73 days. Upon laparoscopy, 16 patients showed signs of adhesions to the cyst. Pathological findings showed the lack of any remaining ovarian tissue in all of the cases. Conclusions: Prenatal ovarian torsion is a condition with distinctive radiological features, the main being a fluid-debris level on sonography. Laparoscopic resection of the cyst has proven to be safe and should be considered in all patients diagnosed with POT.

Keywords

• Ovarian torsion
• Fluid-debris level
• Neonate
• Ultrasonography
• Autoamputation