Male1: Sometimes, we are called down to the emergency room and they do a sonogram with the girl’s ovaries and they say one of them is twisted? How can an ovary twist?
Male2: Somebody in about 1920 said that it came from cranking an automobile, well, we do not crank our automobiles anymore, so I guess that is not the only answer. The people said it came from gymnastics from a little kid doing summersaults. It probably has to do with a certain looseness that some ovaries are just attached to the ligaments as others, but it is true that an ovary suspended on the fallopian tube, inside a girl, she has got a uterus and a fallopian tube hanging like branches from a tree, one on each side. At the tips of which are ovaries and if that ovary twists on the fallopian tube, it gets choked, on the fallopian tube, it gets choked, loses its blood supply and that is a real emergency.
Male1: If you get surgery, do you have to open up the whole belly or do you go down with a little scope?
Male2: So the skill of pediatric surgeon today, modern approach is to use minimal invasive approaches, tiny little trocar incisions and you can untwist that ovary and even if you have to remove it, even if you decide to remove it, it can be done with a very small incision in many cases.
Male1: Sometimes they see fluid, a big fluid sac around the ovary and that is the surgery that is women becoming women because they get sometimes a gluteal cyst.
Male2: That is very interesting because during the reproductive years, when girls are releasing eggs from the age ten to eleven to age 50, little cysts form as part of the normal fertility processes as eggs are released in the middle of the menstrual cycle and making the woman fertile, but amazingly, that starts in utero. Little ovaries in utero are stimulated by hormones and nowadays, we see patients who are not yet born because they have cysts on their ovaries. Little clear cysts, that is normal physiology and if left alone will usually just resolve and be fine.
Male1: But the trick is—it is fluid in a sac from the ovary. That is always benign, is that correct?
Male2: Yes, it is always benign in a little tiny baby and occasionally that can cause a twisting of the ovaries, so that has to be looked at carefully by a good sonographer and a good pediatric surgeon with some familiarity.
Male1: If it is on the ovary, that is not fluid and enlarging, that is not such a good thing to hear, is that true?
Male2: Well cancer of the ovary in the first months and weeks of life is essentially unheard of, but in older child, if there is something more solid growing, it can be tumor. The most common tumor we see in a girl’s ovary is benign. It needs to come out, but it is benign, it is called a teratoma. There are cancers unfortunately, that is terrible, endocarcinoma of the ovary that is such a threat to women is rare in children, fortunately, but like most things in pediatrics, children make different kinds of cancers, often times more treatable than the adult variations and they still need attention.
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