Cerebral Infarction During Laparoscopic Ovarian Cystectomy in a Neonate: A Case Report

Cerebral infarction following abdominal surgical procedures is a rare but serious complication in children. We report a rare case of a full-term neonate who developed a cerebral infarction after laparoscopic ovarian cystectomy.

A neonate weighing 2350 g was prenatally diagnosed with a 30 mm complex ovarian cyst that was suspected to be torsional. At 3 days of age, she underwent laparoscopic ovarian cystectomy under general anesthesia. During the procedure, the twisted ovarian cyst, located in the upper abdomen, was excised after fluid drainage. The surgery lasted 64 min, with a pneumoperitoneum time of 33 min at a pressure of 8 mmHg. The surgery was uneventful. Hemodynamics were managed with fluid and albumin administration throughout the procedure. After pneumoperitoneum, blood pressure was decreased temporally, and ephedrine was administered, which led to recovery. However, at 12 h after surgery, cranial ultrasonography revealed a high-density area in the left basal ganglia, which was not detected in the head ultrasound preoperatively. This was later confirmed to be a cerebral infarction by magnetic resonance imaging (MRI). No cardiac or vascular malformations or hypercoagulability were observed. No additional treatment was administered for cerebral infarction. She was discharged 14 days after surgery. Follow-up MRI at 3 years post-surgery indicated chronic infarction. Fortunately, the patient exhibited no neurological abnormalities.

This case highlights the importance of identifying and mitigating the perioperative risks of cerebral infarction to improve the outcomes of laparoscopic surgery in neonates.