Doctors at Mumbai's Motherhood Hospitals gave a new lease of life to 10-year-old girl by carrying out low impact laparoscopic surgery on a 10-year-old girl to remove a paraovarian cyst, the size of a small melon.
The patient was able to get rid of abdominal pain and vomiting immediately after the surgery and resumed school with ease in the following week.
Swara Tole, the 10-year-old girl, a resident of Kharghar suddenly complained of severe abdominal pain with multiple episodes of vomiting. Her family members took her to the pediatrician, who suspected it to be common stomach flu, and gave her some medications.
After three days, she had a similar episode again, but her condition worsened as the abdominal pain increased in severity.
Her parents took her to a senior gynecologist, who suggested them to go for a sonography, which was performed, diagnosing a large ovarian cyst, with no torsion.
Later she prescribed a trial of contraceptive pills to dissolve the cyst. Since her pain and repeated episodes of vomiting were not decreasing, the parents wanted to go for a second opinion.
The patient was then referred to Dr Jainesh at Motherhood Hospital, from Kharghar.
Dr Jainesh, Consultant Advanced Gynecologic Endoscopic Surgeon, Motherhood Hospitals, Kharghar, said, “On arrival, the patient appeared to have continuous discomfort even while she was sitting in the consulting chamber. She was struggling with continuous deep throbbing pain in her lower abdomen. However, surprisingly her vomiting had completely settled without any medication.”
“This discrepancy raised my suspicions, and I probed a little more into the exact course of the condition. A second round of sonography was performed, which revealed a large paraovarian cyst, however again without torsion,” Dr Jainesh added.
He said that a paraovarian cyst is a fluid-filled sac lying next to the ovary, a non-cancerous pathology. It is usually silent, and asymptomatic, however if complications arise including internal bleeding or infection it can have symptoms like vomiting and severe abdominal pain. In the pediatric population, they are very rare and contribute to less than 4% of any form of pelvic cysts.
In the very early stages of pregnancy, a baby has two structures called a Mullerian duct and Wolffian duct. These become the female and male sexual organs, respectively.
In the case of a baby girl, the Mullerian duct evolves into the uterus, cervix, fallopian tubes, and vagina and the Wolffianvijay duct undergoes resorption. In rare cases Wolffian duct remnants, under hormonal influence, start secreting fluids leading to the formation of such cysts. The cysts are usually silent and only incidentally diagnosed on random sonograms. Younger unmarried girls rarely develop this with the average age of presentation around 15 years. Paraovarian cysts in teens often grow large as no routine sonographies are performed and hence, they are missed.
Dr Jainesh added, “The girl had attained puberty a few months back and had around 3 menstrual cycles, regular in nature. It wasn’t a precocious puberty. When the repeat sonography gave the diagnosis of para-ovarian cyst which showed symptoms, the parents were counselled about surgery. Although OC pills aren’t the solution to get rid of para-ovarian cysts, we didn’t stop her ongoing pills as they would have disturbed her hormonal cycle and likewise menses.”
“In successive days, a special technique of Low Impact Laparoscopy surgery was performed. The intra-operative finding confirmed my suspicions of 2 twists in the large Para ovarian cyst, associated with another rare condition of Isolated Fallopian Tube Torsion. Through small 3 sub centimetric incisions a quick surgery was performed, without a single drop of blood loss,” Dr Jainesh explained.
He said that the entire cyst was removed using state of the art technology and removed through the existing instrument incisions itself. The fallopian tube and ovarian normal anatomical relation were restored, so that her future fertility is unaffected by this surgery.