Stephen E. Dolgin, Chief of Pediatric Surgery, talks about twisted ovary.
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Host: Sometime we are called down to the emergency room and they do a sonogram of the girl's ovaries and they say, one of them is twisted. How can an ovary twist? Guest: Somebody in about 1920 said that it came from cranking an automobile. Well, we don't crank our automobiles any more. So, I guess that's not the only answer. People said it came from gymnastics, from a little kid doing somersaults. It probably has to do with a certain looseness that some ovaries, just aren't as attached to the ligaments as others. But it is true that an ovary is 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, the tips of which are ovaries, and if that ovary twists, on the fallopian tube, it gets choked, looses it's blood supply and that's a real emergency. Host: And if you did surgery, do you have to open up the whole belly or do you go down a little bit. Guest: So, the skilled pediatric surgeons today, modern approach is to use minimally 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 very small incisions in many cases. Host: Sometimes they see fluid, a big fluid sac around the ovary and that isn’t surgery that's woman becoming woman, because it can sometimes a gluteal cyst. Guest: It's very interesting because during the reproductive years, the girls are releasing eggs. From age 10, 11 to age 50, little cysts form as a part of the normal fertility processes. Eggs are released in the middle of the menstrual cycle and making that women fertile. But amazingly that starts in utero. Little ovaries in utero are stimulated by hormones, and nowadays we see patients who aren't yet borne, because there are cysts on their ovaries. Little clear cyst, that's normal physiology and if left alone, will usually just resolve an be fine. Host: But the trick is it's fluid in a sac from the ovary, that's how we split it. Is that correct? Guest: Yes, it's always been lying in the little tiny baby and occasionally that can cause a twisting of the ovaries. So, it has to be looked at carefully by a good sonographer and a good pediatric surgeon with some familiarity. Host: If there is a -- it’s on the ovary, there is a fluid that's enlarging, that isn't such a good thing to hear, is that true? Guest: 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, then it can be a tumor, the most common tumor we see in the girls’ ovaries is benign, it needs to come out, but it's benign, it's called the teratoma. There are cancers, unfortunately it's terrible, adenocarcinoma 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. Oftentimes more treatable than the adult variations and they still need attention.
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