Ovarian Torsion, Ovarian Cyst vs. Ovarian Torsion, Prenatal
Left picture: The final diagnosis is an acute torsion of the right ovary which was recognized late, its cause being a large ovarian cyst. Notice at the lower border of the mass the torsion of the ovarian ligament including the fallopian tube up to the uterus, and the irreversible damage of the ovary. In girls of all ages an ovarian torsion is a relatively frequent differential diagnosis of a surgical abdomen. Right picture: Here, the state of an ovarian torsion in the newborn is present which dates back to the pregnancy. The homogeneous brown discoloration points to a former hemorrhage in the twisted ovary including the cyst, which led to a degradation of the bleeding and the tissue which occurred some time ago. Therefore, the fallopian tube is not recognizable any more. Although congenital ovarian cysts may lead to a torsion at any time - even postnatally - , the typical clinical presentation is a palpable and - as the case may be - even visible abdominal tumor in the newborn and young infant because the torsion has already occurred prenatally, or a postnatal torsion may not be recognized as such due to a misinterpretation of episodes of crying.
Left picture: Operative findings in a 9-year-old girl with a surgical abdomen with severe abdominal pain and prominent lower belly. Following laparotomy a huge, partly grey, partly brown discolored mass is visible with a maximum size of 9 to 10 cm. Right picture: Operative preparation of a 7-day-old newborn girl which has been operated on due to a large abdominal mass. The tumor has a maximum size of 7 cm and is homogeneously discolored brown.