WOFAPS 2025 8th World Congress of Pediatric Surgery

Tunç Tığlı, Tutku Soyer, Özlem Boybeyi

Hacettepe University Faculty of Medicine Department of Pediatric Surgery

Introduction: Depending on the size and the cyst appearance on ultrasound, most of the the prenatal diagnosed neonatal ovarian cyst (NOC) may have spontaneous resolution whereas others with torsion require early surgical intervention. Intraoperative assessment of ovarian viability is often based on subjective macroscopic findings and ovarian tissue should be preserved if possible. Recently, indocyanine green (ICG) fluorescence imaging has emerged as a promising technique to objectively evaluate tissue perfusion and guide surgical decision-making. A- five month-old female with prenatal diagnosed NOC is reported to discuss the use of ICG in the evaluation of ovarian parenchyma in infants.

Case: A five-month-old female infant diagnosed as right adnexal cystic lesion prenatally. Postnatal ultrasonography revealed a 54×60×45 mm septated cyst in the right adnexal region and right ovary did not visualized separately. Upon ultrasound findings and size of the cyst, diagnostic laparoscopy was performed with the presumptive diagnosis of prenatal torsion. Intraoperatively, multiple torsions of the right ovary and fallopian tube were observed. After intravenous administration of ICG, near-infrared fluorescence imaging demonstrated absent perfusion in the whole right ovary with no preserved ovarian parenchyma. The left ovary had normal vascularity. Based on these findings, a right salpingo-oophorectomy was performed. Histopathological examination revealed necrotic and calcified fibrous tissue with hemosiderin-laden macrophages; no viable ovarian stromal or follicular structures were identified.

Conclusion: This case highlights the feasibility and reliability of intraoperative ICG fluorescence imaging in the assessment of ovarian perfusion in NOC. The objective vascular assessment facilitated a confident surgical decision and potentially avoided a futile organ-preserving attempt. Broader implementation of ICG technology, particularly in infants and young children, may enhance fertility-preserving strategies in emergency gynecologic surgery