Para-ovarian cysts occur rarely in young girls but they often grow large as no routine sonographies are performed in this population group.
In a rare case, a team of doctors in Mumbai removed a large para-ovarian cyst, as big as the size of a small melon, from a 10-year-old girl. Para-ovarian cyst occurs rarely in the pediatric age group and is commonly seen in women who are in their 30s and 40s.
The doctors’ team led by Dr Jainesh Doctor at Motherhood Hospitals, Kharghar, performed a low impact laparoscopic surgery to remove the para-ovarian cyst from the girl. Let’s understand the causes and symptoms of this rare condition.
Causes and symptoms of para-ovarian cysts
As explained by the doctors, a para-ovarian cyst is a fluid-filled sac lying next to the ovary, a non-cancerous pathology. Such cysts are usually silent, and asymptomatic. However, sometimes complications may arise including internal bleeding or infection that can cause symptoms like vomiting and severe abdominal pain. In the pediatric population, they are very rare and contribute to less than 4 per cent of any form of pelvic cysts.
In the very early stages of pregnancy, a baby has 2 structures called a Mullerian duct and Wolffian duct. These become the female and male sexual organs, respectively. If the baby is a girl, the Mullerian duct evolves into the uterus, cervix, fallopian tubes, and vagina and the Wolffianvijay duct undergoes absorption. Rarely, Wolffian duct remnants, under hormonal influence, may start secreting fluids leading to the formation of such cysts. Typically, the cysts are silent and only incidentally diagnosed on random sonograms. It is rarely seen among younger unmarried girl, with the average age of presentation around 15 years. However, para-ovarian cysts in teens often grow large as no routine sonographies are performed in this population group and the cysts are often missed.
In this case, the girl’s condition first came into notice when one day she suddenly experienced severe abdominal pain with multiple episodes of vomiting. She was taken to a pediatrician, who suspected it to be common stomach flu, and gave her some medications. But three days later, she had a similar episode again, with more severe abdominal pain. Then her parents took her to a senior gynecologist, who suggested for a sonography. The test showed a large ovarian cyst, with no torsion. Following the diagnosis, the girl was given contraceptive pills to dissolve the cyst, however, she continued to experience severe abdominal pain and repeated episodes of vomiting.
For a second opinion, the parents consulted Dr Jainesh Doctor, Consultant Advanced Gynecologic Endoscopic Surgeon, Motherhood Hospitals, Kharghar.
Dr Jainesh stated that when the girl was brought to him, she complained of continuous deep throbbing pain in her lower abdomen. Though her vomiting had completely settled without any medication, she continued to struggle with the pain. A second round of sonography was performed, which revealed a large para-ovarian cyst, however again without torsion.
Treatment of para-ovarian cysts
Does having a para-ovarian cyst affect menstrual cycles? According to Dr Jainesh, the girl aged 10 had a precocious puberty and had around three menstrual cycles, regular in nature.
Dr Jainesh noted that contraceptive pills aren’t the solution to get rid of para-ovarian cysts, but they allowed the girl to continue her ongoing pills as that would have disturbed her hormonal cycle and likewise menses. In successive days, a low impact laparoscopy surgery was performed to remove the cyst.
During the operation, they found two twists in the large para ovarian cyst, associated with another rare condition of Isolated Fallopian Tube Torsion. The entire cyst was removed, and the fallopian tube and ovarian normal anatomical relation were restored, to preserve her fertility.
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Post source: The Health Site