Laparoscopic Removal of Auto-amputated Adnexa in Newborns and Infants

Introduction: Adnexal auto-amputation is a rare complication of fetal ovarian torsion. We present a case of adnexal auto-amputation and its laparoscopic treatment in a newborn. In this article, to discuss different techniques, we also reviewed newborn and infant cases of adnexal auto-amputation reported in the literature and treated laparoscopically. Case Description/Technique Description: A 2-week-old newborn with a preoperative ultrasonography suggesting a possible auto-amputation of the left ovary underwent laparoscopic 2-trocar removal of a hemorrhagic cyst measuring 4.5 cm in diameter. Laparoscopy was performed, without any major intraoperative complications such as bleeding, rupture, or leakage. All structures were correctly identified. After transabdominal suction, the hemorrhagic cyst was delivered from the umbilical 10-mm port and removed. The presence of a blind adnexal stump was evidence of auto-amputation. The contralateral ovary was verified. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. Discussion: Although laparoscopic removal of auto-amputated adnexa can be successfully accomplished in newborns and infants, 50% of auto-amputated adnexa are still treated by laparotomy. Our review revealed the necessity of 2 ports for identification and removal of the adnexa by laparoscopic-assisted technique, while 3 trocars proved useful in the presence of tenacious adhesions.