10-year-old operated for para ovarian cyst

10-year-old Swara was diagnosed with a melon-sized para-ovarian cyst, a rare condition in pediatric populations contributing to less than 4% of pelvic cysts. After a trial of contraceptive pills failed, a low-impact laparoscopy surgery was performed to remove the cyst and restore normal anatomical relations. The surgery was successful, and the patient's future fertility is unaffected.

NAVI MUMBAI: For Lalit Tole and Arti Kaley, their life turned upside down when they found that their only child, 10-year-old Swara had a melon sized para-ovarian cyst- a very rare condition in pediatric population which contribute to less than 4% of any form of pelvic cysts.

10-year-old operated for para ovarian cyst

It was a nightmare for them to see their daughter suffer with severe abdomen pain and vomiting episodes. She was taken 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.

She was then taken to a senior gynecologist, who diagnosed a large ovarian cyst. Later she prescribed a trial of contraceptive pills to dissolve the cyst. But, since there was no improvement in her condition, the parents went for a second opinion to Dr Jainesh Doctor at Motherhood Hospital, from Kharghar. The episodes started in the beginning of the month of May and after a week; she was detected with the cyst.

Dr Jainesh Doctor, Consultant Advanced Gynecologic Endoscopic Surgeon, Motherhood Hospitals, Kharghar, said the patient struggled with deep throbbing pain in her lower abdomen but her vomiting condition had stabilised without medication. “This discrepancy raised my suspicions, and a second sonography was performed, which revealed a large para-ovarian cyst.”

A para-ovarian 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, doctor added.

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 Wolffianv duct undergoes absorption.

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. Para-ovarian cysts in teens often grow large as no routine sonographies are performed and hence, they are missed.

Dr Doctor added, “The girl had attained puberty a few months back and had around three menstrual cycles, regular in nature. When the repeat sonography gave the diagnosis of para-ovarian cyst which showed symptoms, the parents were counselled about surgery.”

He said a low impact Laparoscopy surgery was performed on the girl which confirmed his suspicions of a large Para ovarian cyst, associated with another rare condition of Isolated Fallopian Tube Torsion. A quick surgery was performed, without a single drop of blood loss and the entire cyst was removed using state of the art technology. “The fallopian tube and ovarian normal anatomical relation were restored, so that her future fertility is unaffected by this surgery. If there would have been delay in surgery, she would have possibly lost her fallopian tube or even the ovarym,” he said.

Her parents said they visited many clinicians to stop the vomiting and abdominal pain. “Finally, we met Dr Himani Gupta, Dr. Jainesh Doctor and their team and timely treatment helped our daughter, preserving her ovary and further resuming her school. She is completely fine now, and doctors have suggested we come for regular checkups whenever needed,” said Tole.