Clinical case of four-day torsion of ovarian teratoma and secondary appendicitis in a child

Abstract

Teratoma (from the Greek τέρατος - monster, ομα - tumor) is a tumor formed from monocytes, common location of which is the ovaries in females, testicles in males, sacrococcygeal area in children, as well as the brain. Teratoma of the ovary is one of the types of germinogenic tumors, which has synonyms of embryo, «parasitic fetus», «complex cell tumor», «mixed teratogenic neoplasm», «monodermoma».

The aim - to analyze the clinical symptoms and diagnostic and treatment tactics for the combined pathology of the appendix and pelvic organs in girls, to draw the attention of the medical staff to the pathology called appendicular-genital syndrome.

Clinical case. We observed torsion of the left uterine appendages in an 11-year-old girl, which caused diffuse serous-purulent peritonitis and secondary phlegmonous appendicitis. Thus, in this case, we can talk about the appendiсular-genital syndrome, which had its origin in the left appendages of the uterus as a result of organic damage and their twisting. Patient Hanna B., 11 years old, was hospitalized on January 25, 2021, in the surgical department № 1 of the Vinnytsia Regional Clinical Hospital with abdominal pain localized above the bosom, in the right and left iliac regions, which lasted for 4 days. During this period, there was also a rise in body temperature within subfebrile values. They were not treated independently. Until the moment of hospitalization, the girl had never had menstruation. The patient was operated on the day of admission to the emergency department due to the presence of the «acute abdomen» clinic. During the surgical intervention, the following findings were revealed: the left uterine appendages were black, swollen with under-capsular hemorrhages, which included a neoplasm with the dimensions and a hyperemic, swollen, injected appendix, which was mace-like thickened at the apex.

In connection with the appearance of complications in the form of peritonitis and the development of secondary appendicitis, operative treatment had the following volume. Left tubovariectomy, appendectomy, sanitation and drainage of the abdominal cavity were performed.

Conclusions. In case of suspicion of appendicular-genital syndrome, it is necessary to use a laparoscopic technique instead of an open one after carrying out pre-operative medical and diagnostic measures. It is laparoscopic surgery that has an advantage over appendictomous access in the right pubic region, because during laparoscopic intervention there is a wider field for examination of the pelvic cavity with the help of a camera.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.