# Case Report: Minimally invasive management of torsion in a giant ovarian cyst in an obese child: a single-port approach combined with extracorporeal cystectomy

## TL;DR

A minimally invasive surgical approach successfully treated ovarian torsion in an obese child with a large ovarian cyst.

## Contribution

A novel single-port laparoscopic technique combined with extracorporeal cystectomy is proposed for pediatric ovarian torsion.

## Key findings

- The procedure achieved successful detorsion and cyst removal with minimal blood loss and rapid recovery.
- Postoperative transaminase levels normalized, indicating reduced hepatic stress.
- Histopathology confirmed a benign ovarian follicular cyst with mild granulosa cell hyperplasia.

## Abstract

Ovarian torsion in children is most commonly associated with benign cystic lesions. The surgical objective is to achieve early detorsion while maximizing ovarian function preservation.

We report a case of an 11-year-and-8-month-old obese girl who had not yet reached menarche. She presented with persistent right lower abdominal pain lasting 40 h. Ultrasound revealed a large right-sided cystic mass with a “whirlpool sign” and an O-RADS 2 classification. CT imaging demonstrated a sizable pelvic cystic lesion with minimal fluid accumulation. Upon admission, ALT and AST levels were 278 and 122 U/L, respectively. Following a multidisciplinary evaluation, a perioperative management plan was devised, focusing on minimizing hepatic metabolic burden. Single-port laparoscopic surgery via the umbilicus confirmed 540° torsion of the right adnexal pedicle. After detorsion, an external ovarian cystectomy and ovarian reconstruction were performed outside the protective sleeve, involving controlled decompression, complete cyst wall excision, meticulous hemostasis, and tissue reconstruction. Intraoperative blood loss was approximately 20 ml. Postoperatively, transaminase levels gradually normalized, and the patient was discharged on postoperative Day 4. Histopathology revealed an ovarian follicular cyst with mild granulosa cell hyperplasia.

Combining single-port laparoscopy with extracorporeal cystectomy provides a safe, minimally invasive solution for pediatric ovarian torsion. This approach reduces operative time, minimizes CO2 exposure, and preserves both ovarian function and appearance, making it a reproducible option for pediatric cases.