The First Report of an Intraperitoneal Free-Floating Mass (an Autoamputated Ovary) Causing an Acute Abdomen in a Child

Abstract

A free-floating intraperitoneal mass is extremely rare, and almost all originate from an ovary. Here, we present the first case with an intraperitoneal free-floating autoamputated ovary that caused an acute abdomen in a child and also review the literature. A 4-year-old girl was admitted with signs and symptoms of acute abdomen. At surgery, the patient had no right ovary and the right tube ended in a thin band that pressed on the terminal ileum causing partial small intestine obstruction and acute abdomen. A calcified mass was found floating in the abdomen and was removed. The pathological examination showed necrotic tissue debris with calcifications. An autoamputated ovary is thought to result from ovarian torsion and is usually detected incidentally. However, it can cause an acute abdomen.

First report of MRI findings in a case of an autoamputated wandering calcified ovary

“…A wandering cystic abdominal mass was demonstrated on antenatal ultrasound in almost all of these cases 1–3. In all cases, in older children, the diagnosis was made after laparoscopy or during surgery 1–3. Only 14 cases of radiologically demonstrated wandering calcified ovary were identified in the literature, and MRI findings have not yet been described in this group 3.…”

“…Autoamputation of an ovary can be unilateral or bilateral, and it can occur during the prenatal or neonatal period 3. It is more common on the right side 1–3.…”

“…Half (49/97) of these cases involved pediatric patients (<18 years) 1–3. Most of these cases were diagnosed via antenatal ultrasonography, likely because it is a very commonly performed examination 3.…”

“…Torsion of an ovary or an ovarian lesion and the adnexa can lead to infarction and necrosis and subsequent amputation of the ovary 1–3. An amputated ovary gets calcified (dystrophic calcification) and may freely float in the peritoneal cavity 3.…”

Diagnosis of neonatal ovarian torsion: Emphasis on prenatal and postnatal sonographic findings

“…Although imaging plays a pivotal role in the detection and diagnosis of ovarian torsion, there seems to be very limited information in the literature about this issue, particularly in neonates and young infants. The radiologic findings of neonatal ovary torsion have been described in case reports or small series studies in the literature, including the in utero torsion of a fetal ovarian cyst . Fetal ovaries are subject to the development of cysts by the stimulation of placental and maternal hormones.…”