Outcome of early minimal surgical intervention for antenatally detected ovarian cyst

Fetal and neonatal ovarian cysts are detected frequently by ultrasonography, the presence of this lesion can result in adnexal torsion in utero with autoamputation and ovarian loss. Neonates with ovarian cysts measuring 5 cm or more in its maximum diameter need surgical intervention, laparoscopic technique considered the most appropriate approach for management of such cysts, however, laparoscopic equipment may be unavailable in most centers, has high costs, and demands a long learning curve, especially in newborns. Early surgical intervention through a minilaparotomy for antenatally detected ovarian cyst will be discussed here. Ultrasound scanning during antenatal care for detection of fetal malformation picked up 23 cases of fetal ovarian cysts during the last 3 years. Cysts measuring 5 cm or more in its diameter at the last trimester and cysts with solid mass like area were diagnosed and confirmed in 11 of them. Post-delivery reevaluation done by ultrasound and hormonal profile for all cases and CT scan done for 7 of them. Minilaparotomy with exteriorization-aspiration ["catch and suck"] had been done for 11 cases. All cases had been operated in the first week after delivery, followed up for a period of 8- 36 months. Small sized cysts [12 cases] were followed up, and only 2 of them need surgical removal later on. 23 cases of ovarian cysts were detected antenatally during the last three years, 11 of them had a maximum diameter of 5 or more centimeters were operated in the first week of life and 12 cases of smaller size were followed up for 2 years and in 2 of them surgical removal were indicated. Average operating time was 35 minutes [range 25-45 mm.]. Postoperative course was uneventful in all cases; no intra- or postoperative complications were recorded. Length of stay in hospital was 48 to 72 hours in all patients. All cases proved histologically to be a simple functional ovarian cyst, except one dermoid cyst. Gestational age of the operated neonates ranged from 3 6-39 weeks. Cesarean section had been indicated for 8 cases and vaginal delivery in 15 cases. Antenatally detected ovarian cyst is not rare and some cases need surgical intervention after delivery to save the ovary and avoid complications. Minilaparotomy for cysts larger than 5 cm with cyst aspiration and subsequent removal may prove a reliable and safe technique in the treatment of neonatal ovarian cyst [NOC], which needs surgical excision. Operating time and length of stay in hospital are not significantly longer than laparoscopic approach, making this procedure a valid alternative

Neonatal intestinal perforation; laparotomy versus drainage

This study included 25 cases of intestinal perforation with and without necrotizing enterocolitis [NEC]. Infants were divided into two groups: Group 1 consisted of 8 infants who had intestinal perforation without evidence of NEC and group 2 consisted of 17 infants who had intestinal perforation with evidences of NEC. A total of 25 infants underwent initial peritoneal damage [PD] for intestinal perforation. In addition, a cohort of 10 infants was obtained by a chart review of premature infants with intestinal perforation treated with primary laparotomy. Outcome of the cohort group was compared with those of the infants treated with primary PD. All infants showed initial improvements after PD. In group 1, all infants survived. Five infants never required laparotomy and drain was removed after 10 +/- 7 days. One infant underwent laparotomy after 48 hours due to failure of improvement, an isolated perforation was found, a diverting stoma was placed, and the infant recovered. Two infants required laparotomy 15 and 17 days after PD. In group 2, all infants improved systemically immediately after PD. Seven infants survived required no additional surgical intervention and all were discharged with intact gastrointestinal function. Four infants developed clinical deterioration and underwent salvage LAP, three underwent bowel resection and placement of diverting stoma and recovered and one had total intestinal necrosis and died. The remaining six infants died without exploration