FOETAL INTRA ABDOMINAL CYST: ANTENATAL DIAGNOSIS AND FOLLOW-UP

Abstract

Small ovarian cysts in the foetus and in newborns are not uncommon. The most common cause of an antenatally observed intraabdominal cyst, excluding those of gastrointestinal and renal etiology is of ovarian origin [1]. Most of these cysts involute within the first few months of life and bear no clinical significance. However, large ovarian cysts are liable to undergo complications like torsion and haem-orrage in the intrapartum or postnatal period or cause dystocia and intestinal obstruction. We present this case of an intraabdominal cyst, in which, the antenatal detection and serial follow-up into the infancy of the child led to timely alerting the paediatric surgeons about development of complications, for necessary intervention. Case Report During routine antenatal ultrasound screening in a primigravida, a 28 weeks old foetus was detected to have a cystic mass. 4×4 cm in size, on the right side of the abdomen, which was followed-up and found to be persistent till term. A differential diagnosis of mesenteric cyst; duplication cyst and ovarian cyst was offered, in view of the foetus being of the female gender. The child was delivered normally at term and had an asymptomatic post-natal period. At 2½ months of age, the infant was brought under medical supervision in view of antenatal counselling. An examination revealed a rounded cystic to firm mass in the right periumbilical region. An ultrasound scan showed a right sided, predominantly cystic mass in the abdomen with hyperechoic areas within, showing no significant change in size [Fig. 1(a) and 1(b)]. A differential diagnosis of mesenteric cyst, duplication cyst and right ovarian complex cystic mass was offered. To ascertain the exact nature and origin of this mass, a CT scan was done, which showed a complex cystic mass with a fluid-debris level and Hounsfield values of 13–14 HU and 20–24 HU respectively, above and below the level [Fig 2]. The same differential diagnosis as on ultrasonography was offered. At 3½ months of age, ultrasound follow-up revealed a well encapsulated cystic mass, measuring 10×10 cm, in the right iliac region, extending into the pelvis, with a fluid level and low level uniform echoes. Floaters of high echogenecity were seen attached to the wall of the cyst. Minimal ascitis was present. Other intra-abdominal organs were normal. A diagnosis of haemorrhage into the ovarian cyst was given. In view of the increase in size and the echogenic contents suggestive of haemorrhage, the child was taken up for surgery. Peroperatively, a 10 × 10 cm, pedunculated, left ovaries cyst was delivered. The right ovary was normal. Post operative recovery was uneventful. Histopathology revealed a large ovarian cyst with extensive infarction and necrosis with calcification in the necrotic zone consistent with a haemorrhagic ovarian cyst. Open in a separate window Figs. 1 a) & b) LS and TS of pelvis of infant showing a large cystic mass superolateral and to right of urinary bladder with low level internal echoes.