Fetal Ovarian Cyst Managed Laparoscopically in the Neonatal Period
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calciuria in type 1 and 2. Hypomagnesemia is seen in minority. Urinary levels of chloride are also very much elevated which helps in differentiating this picture from chronic vomiting and cystic fibrosis. The tubular defect in Bartter or Gittlemann syndrome cannot be corrected [6], but with careful fluid and electrolyte management, long term prognosis is good. We treated the child with proper fluid and electrolyte correction following which hyperkalemia improved. The potassium levels normalised after a period of eight days without any therapy for potassium corrections except for restriction. Urinary electrolytes continued to remain elevated. The child was discharged in a stable condition after establishing oral feeds.
1. Sinha A, Bagga A. Tubular disorders. In: Srivastava RN, Bagg A, editors. Pediatric Nephrology, 6th edition. Jaypee publishers; 2016. p. 312-16. 2. Dixon BP, Bartter syndrome, inherited tubular transport abnormalities. In: Kliegman, St Geme, Blum, Shah, Tasker, Wilson, editors. Nelsons Textbook of Paediatrics, 21st edition. Elsiever; 2019. p. 2767-9. 3. Kurtz I. Molecular pathogenesis of Bartter’s and Gitelman’s syndromes. Kidney Int. 1998;54:1396-410. 4. Simon DB, Karet FE, Rodriguez-Soriano J, Hamdan JH, DiPietro A, Trachtman H, et al. Genetic heterogeneity of Bartter’s syndrome revealed by mutations in the K+ channel, ROMK: Classic diseases revisited. Nat Genet. 1996;14:152-6. 5. Laghmani K, Beck BB, Yang SS, Seaayfan E, Wenzel A, Reusch B, et al. Polyhydramnios, transient antenatal Bartter’s syndrome, and MAGED2 mutations: N Engl J Med. 2016;374:1853-63. 6. Fujita T, Ando K, Sato Y, Yamashita K, Nomura M, Fukui T. Independent roles of prostaglandins and the reninangiotensin system in abnormal vascular reactivity in Bartter’s syndrome. Am J Med. 1982;73:71-6.
The child followed-up with us two weeks after the discharge which was uneventful. Our case focuses light on the rare presentation of Bartter syndrome with acute kidney injury probably due to nephrocalcinosis which might have started in utero. RAVI TEJA JALADI,* ARNAB BISWAS AND SONALI MITRA Department of Paediatrics, Nil Ratan Sircar Medical College and Hospital, West Bengal, Kolkata, India. *[email protected]
Fetal Ovarian Cyst Managed Laparoscopically in the Neonatal Period
cyst, and uterus, left ovary and left kidney were normal. Plain Xray abdomen revealed displacement of bowel loops to left side. These findings were consistent with the diagnosis of ovarian cyst with internal hemorrhage (complicated). A thyroid scan performed later was normal. Laparoscopic excision of cyst with preservation of rest of the ovary was performed using three ports and a maximum of 10mm pneumo-peritoneum on day 8 of life. The cyst was seen to originate from right ovary, had a short pedicle and had undergone torsion on its own axis. Dark brown color fluid was aspirated from cyst, which was excised with Harmonic as energy source. Histopathological examination of excised cyst revealed complicated ovarian cyst with necrosed wall. Left ovary was normal.
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