Huge adnexal masses in children are uncommon and therefore approach to management may pose a challenge; particularly in an obese one.
A 10 year old girl, with a BMI of 38 kg/m2, underlying metabolic syndrome and obstructive sleep apnoea, presents with a 2 month history of excessive weight gain and progressive abdominal distension. Examination revealed a cystic mass in the abdomen, corresponding to a 28 week-size gravid uterus. Ultrasound & CT imaging was done, revealing a huge intraperitoneal cystic mass arising from pelvis, measuring 11.2 x 23.3 x 21.9 cm in size, with both ovaries normal bilaterally. Serum markers were within normal range.
A minimally invasive approach was offered in view of her age and co-morbid. A modified laparoscopic drainage and cystectomy was performed for therapeutic & diagnostic purpose.
Intraoperative findings revealed a huge para tubal cyst arising from left fallopian tube. Four litres of clear fluid drained and cystectomy was performed.
Conclusion: Minimally-invasive approach to large adnexal masses is an alternative, possibly superior, approach to management of large para tubal cyst in children & adolescents.