EC Gynaecology

Introduction: Fetal ovarian cysts are the most common prenatally diagnosed abdominal masses in female neonates. While many regress spontaneously, large cysts carry a significant risk of complications, including torsion.

Case Presentation: We report the case of a female neonate with a large (6 x 7 cm) multiloculated abdominal cyst, first detected at 37 weeks' gestation. Postnatal ultrasound and MRI confirmed a likely ovarian origin. Serial monitoring showed no regression and a slight increase in size (6.5 cm max diameter), with imaging features suggestive of a hemorrhagic "chocolate" cyst. Due to the persistent size and elevated torsion risk, she underwent an elective laparoscopic right oophorectomy at 10 weeks of age. Intraoperative findings confirmed a large, non-viable, hemorrhagic cyst adhered to the anterior abdominal wall, consistent with prior torsion. The procedure was uncomplicated, and the patient was discharged on postoperative day one.

Conclusion: This case highlights the standard diagnostic pathway for large fetal ovarian cysts, underscores the importance of serial postnatal imaging, and demonstrates that laparoscopic intervention is a safe and effective management strategy for large, complex, or non-regressing cysts to prevent complications and preserve future fertility where possible.

 Keywords: Fetal Ovarian Cyst; Neonatal Surgery; Laparoscopic Oophorectomy; Prenatal Diagnosis; Chocolate Cyst; Case Report

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