[Voluminous ovarian cyst in children. Therapeutic strategy]

Ovarian cysts are rare in children but can sometimes become extremely large, leading to difficult therapeutic decisions. There is general agreement that the therapeutic attitude for benign serous cysts less than 5 cm in diameter includes echographic monitoring and possible echo-guided punction. For cysts larger than 5 cm, most authors favour cystectomy via the celioscopic route using either celio-surgery or mini-laparotomy. On the contrary, the clinical manifestations of large cysts greater than 15 cm in diameter may vary greatly, presenting as increased abdominal volume, pain, respiratory impairment. The large size of the cyst should not be allowed to mask an associated torsion of the annexes in cases of paroxysmal abdominal pain. We report our experience of 6 voluminous ovarian cysts with a largest diameter varying between 15 and 40 cm. The children's age varied from 10 to 15 years. There were 3 dermoid cysts, 2 treated by ovariectomy and 1 by celio-surgery, 1 torsion of the annexes on dermoid cyst was treated via laparotomy. There were two cases of mucinous cystadenomas, 1 treated by mini-laparatomy and the other by celio-surgery. Finally one serous cyst with torsion of the annex was treated by annexectomy. The large size of the cysts may impair the surgical approach. Prudent ceilo-surgery should be preferred to wide laparotomy. Introduction should be performed under visual control followed by leak-free punction. The cyst is emptied before exeresis of the ovary via a mini-laparotomy since, in many of these cases of voluminous tumours, cystectomy cannot always be performed and ovariectomy must be preferred.