Case Report

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

Table 1

Cases of autoamputated free-floating ovaries in children.

No.ReferenceAgeClinical and imaging featuresSize (cm)SideSurgical findingTreatmentPathology

1[1]12 yAbdominal pain, no PM, PXR, mobile pelvic calcified mass3.0 × 2.2RAbsent RO and partial RFT, calcified FFMLTSolid NT with calcification
2[2]3 yIncidental calcification on IVU for UTI, asymptomatic, no PM, PXR, mobile pelvic calcified massUKRUKUKUK
3[2]4 yIncidental calcification on hip X-ray for lower extremity pain, asymptomatic, no PM, PXR, mobile pelvic calcified massUKLUKUKUK
4[3]17 mMobile fluctuant nontender mass on a routine PE, history of colic pain, PM, PXR, calcified mass, IVU, normal5.0RAbsent RO and RFT, cystic greenish-brown FFM attached to the omentumLTNT, fibrosis, hemorrhage, calcification, no VOT
5[3]5 mSoft nontender mass on a routine PE, asymptomatic, PM, PXR, irregular calcification in the lower abdomen, IVU, normal4.0 × 3.0RAbsent RO, rudimentary RFT, cystic FFM attached to the omentumLTCalcified fibrous NT
6[3]9 yIncidental calcification in PXR for undetermined reason, asymptomatic, no PM, PXR, calcification, IVU, normal3.0 × 2.3RAbsent RO, calcified FFM, normal fallopian tubes and LOLTNT with calcification, no VOT
7[3]2 wMobile nontender mass on a routine PE, asymptomatic, PM, IVU and barium enema, normal3.0 × 1.5RAbsent RO and RFT, cystic FFM attached to the retroperitoneum and ascending colonLTOvarian stroma and follicles, calcified NT, fibrous wall
8[4]3 mCM in AUS at 38-GW, asymptomatic, no PM, US, mobile CM4.0RAbsent RO, atretic RFT, cystic FFMLTNT, fibrotic walls, no VOT
9[5]4 dCM in AUS at 38-GW, asymptomatic, no PM, lower abdominal fullness, PXR, noncalcified mass, US, CM8.0RAbsent RO, hemorrhagic cystic FFMLTNT
10[6]2 yIncidental bilateral pelvic calcification in IVU for recurrent UTI, asymptomatic, no PM, US and CT, bilateral pelvic calcifications3.5 × 2.5
2.5 × 2.0
BLTwo FFMs in the cul-de-sac, absent ovaries, normal uterus, and fallopian tubesLTExtensive NT and calcification
11[7]2 yRecurrent abdominal pain, PM, abdominal tenderness, PXR, soft tissue mass with calcification, US, CM with solid component6.5RAbsent RO and RFT, cystic FFM attached through a long pedicle to mesentery of colonLTUnilocular cyst filled with thick fluid with calcified mural nodule
12[7]14 mRight lower quadrant mass on PE for abdominal pain, PM, PXR, calcified mass, US, CM with a solid mural nodule5.0 × 4.0RAbsent RO and RFT, cystic FFM attached to liver through twisted pedicle of omentumLTCM, shaggy tan-pink interior with gritty mural nodule
13[8]2 wCM in AUS at 26-GW, asymptomatic, no PM, US, CM in the right upper quadrant, fluid-fluid level6.0 × 6.0RAbsent RO, cystic FFMLTAseptic necrosis of ovary with pseudocyst formation
14[9]5 mCM in AUS at 30-GW, asymptomatic, no PM, US, complex ovarian cyst with calcification6.5UKAutoamputated cystic ovarian FFMLTUK
15[9]7 mCM in AUS at 34-GW, asymptomatic, no PM, US, complex ovarian cyst with fluid debris level3.0UKAutoamputated cystic ovarian FFMLTUK
16[10]8 yIncidental calcification on a PXR obtained for UTI, asymptomatic, no PM, PXR, CT and VCUG, calcification adjacent to the pubic bone3.0 × 3.0RAbsent RO, calcified FFMLTNecrotic partially calcified mass, no VOT
17[11]11 mCM in AUS at 34-GW, asymptomatic, freely mobile PM, US, ovarian cyst with fluid/debris level4.0RAbsent RO and RFT, cystic FFMLTNT, no VOT
18[12]6 yIncidental calcified mass on a PXR obtained for coin ingestion, asymptomatic, no PM, US, absent LO, CT, mobile calcified pelvic mass2.2 × 1.7LAbsent LO and LFT, calcified FFMLSAmorphous calcified tissue, no VOT
19[13]5 m*CM in AUS at 38-GW, asymptomatic, mobile PM, US, right-sided cystic pelvic mass with echogenic finding4.2 × 3.7LAtretic LFT covered with peritoneum, cystic FFMLSExtensive NT and autolysis with calcification
20[14]NeonateUKUKULAutoamputated cystic ovarian FFMLSUK
21[15]6 wCM in AUS, asymptomatic, no PM, US, hemorrhagic RO cyst4.0 × 3.0RAbsent RO and RFT, cystic FFM attached to the omentumLSHemorrhagic infarction with calcification
22[16]5 mTwo CM in AUS at 17-GW, asymptomatic, no PM, US, two CM with septations3.5 × 2.5
3.8 × 1.8
BLNo ovaries, two cystic FFMs, normal uterus and fallopian tubesLTHemorrhagic ovaries with calcification
23[17]InfantAsymptomatic, no PM, US, CMUKULCystic FFMLSNo VOT
24[18]3 mCM in AUS at 27-GW, asymptomatic, no PM, US, ovarian cyst with fluid debris level5.0UKCystic FFMLTOvarian NT, hemorrhage, calcification
25[19]4 w*CM in AUS at 32-GW, asymptomatic, no PM, US, CM in the right side4.5LAbsent LO and LFT, hemorrhagic cystic FFM adhered loosely to peritoneumLSNo VOT, hemorrhagic NT
26[20]3 mCM in AUS at 24-GW, asymptomatic, no PM, US, pelvic CM4.0 × 3.5UKAutoamputated cystic ovarian FFMLTCystic ovary with NT
27[21]3 wCM in AUS at 30-GW, asymptomatic, no PM, US and CT, CM with calcification, MR, hemorrhagic mass3.2 × 2.0RAbsent RO and RFT, cystic FFMLTNT, hemorrhage, autolysis with calcification, no VOT
28[22]2 dCM in AUS at 32-GW, asymptomatic, mobile PM, US, a free-floating CM without blood support with fluid/debris level6.0 × 5.2LCystic FFMLSNT, no VOT
29[22]2 dCM in AUS at 34-GW, asymptomatic, no PM, US, a free-floating CM on the right without blood support5.0 × 4.5LAbsent LO and LFT, autoamputated cystic ovarian FFM in the right abdomenLSHemorrhagic infarction with calcification
30[23]1 dCM in AUS at 37-GW, PM in right lower quadrant, US and CT, complex CM with calcification in the right lower quadrant6.0 × 6.0LAbsent LO and LFT, cystic FFM attached to the omentum in the right lower quadrantLTHemorrhagic infarction with calcification
31[24]3 dCM in AUS after 30-GW, abdominal distention, intestinal obstruction, respiratory distress syndrome, US, complex CM8.0RAutoamputated RO fixed to mesentery and terminal ileum leading to ischemia for 15 mmLTHemorrhagic infarction with calcification, no VOT
32[24]10 mCM in AUS after 30-GW, asymptomatic, no PM, US, complex CM4.0LAutoamputated LO in retrovesical areaLTHemorrhagic infarction with calcification, no VOT
33[24]3 mCM in AUS after 30-GW, asymptomatic, no PM, US, complex CM5.5LAutoamputated LO connected with right adnexaLTHemorrhagic infarction with calcification, no VOT
34[24]17 dCM in AUS after 30-GW, asymptomatic, no PM, US, complex CM2.9LAutoamputated LO connected to cecum with adhesionsLSHemorrhagic infarction with calcification, no VOT
35[25]4 d*CM in AUS at 28-GW, asymptomatic, no PM, US and MR, right side CM4.0 × 3.5LAbsent LO, autoamputated FFM in the right side abdomenLSNT with small amount VOT
36Uygun et al. (Present Case) 20124 yAcute abdomen, intestinal obstruction and recurrent abdominal pain symptoms (tenderness, vomiting), US, free fluid, PXR, normal2.8RAbsent RO and RFT ending with band on cecum and pressuring ileum, calcified FFMLTNT with calcification

AUS: antenatal ultrasonography, CM: cystic mass, PE: physical examination, IVU: intravenous urography, PXR: plain X-ray, UTI: urinary tract infection, VCUG: voiding cystourethrography, FFM: free-floating mass, R: right, L: left, BL: bilateral, UL: unilateral, UK: unknown, LT: laparotomy, LS: laparoscopy, LO: left ovary, RO: right ovary, RFT: right fallopian tube, LFT: left fallopian tube, NT: necrotic tissue, VOT: viable ovarian tissue, MRI: magnetic resonance imaging, CT: computed tomography, US: ultrasonography, PM: palpable mass, GW: gestational age, d: days, w: weeks, m: months, y: years.
*Preoperative diagnosis of autoamputated ovary.