Bir Yenidoğanda Gebelik Sırasında Aile İçi Şiddete Bağlı İntraabdominal Hemorajik Kist

Abstract

Yenidoğan döneminde kistik karın kitleleri oransal olarak daha sıktır. Mezenterik ve over kistleri daha yaygındır fakat hemorajik kistler çok nadirdir. Hemorajik kistler şiddet, kazara düşme, motorlu taşıt kazaları gibi gebelik sırasında künt travmalara bağlı olabilir. 41 günlük kız, antenatal ultrasonunda sağ over bölgesinde lokalize intraabdominal kist saptanması üzerine yatırıldı. Postnatal MRI’ da pelviste 50x30x30 mm. heterojen kistik kitle görüntülendi. Bebeğin annesi gebeliğinin 5. ayında aile içi şiddete bağlı künt karın travmasına maruz kalmıştı. İnen kolonun mezenterine küçük bir bağlantısı olan kitle kolayca çıkarıldı. Kolonun mezenterinde anneye ait travmanın neden olduğu hematom olduğu düşünüldü. Her iki böbrek ve overler normal görünümdeydi. Şanslı olarak, hematom kolon ve diğer karın içi organların dolaşımını bozmamış ve basit hemorajik kist haline gelmişti. Kitlenin histopatolojik incelenmesi hemorajik, nekrotik basit kist olarak rapor edildi. Fetal kitleler için antenatal ultrasonografi seçkin yöntemdir. Bu kitlelerin postnatal olarak abdominal MRI ile değerlendirilmesi gerekli olabilir. Bazı fetal kitleler bizim olgumuzda olduğu gibi gebelik sırasında künt travmaya bağlı olabilir. Bu nedenle annenin anemnezi dikkatlice aile içi şiddet ve travma yönüyle alınmalıdır. Bilgilerimize göre, antenatal künt travmaya bağlı yenidoğan hemorajik kist şimdiye kadar literatürde rapor edilmemiştir.

Keywords

• İntrauterin, travma, hemorajik, kist, aile içi şiddet

INTRAABDOMINAL HEMORRHAGIC CYST IN A NEWBORN DUE TO DOMESTIC VIOLENCE DURING PREGNANCY

Abstract

Cystic abdominal masses are relatively common in neonatal period. Among all cystic abdominal masses in neonatal period; mesenteric and ovarian cysts are more common, whereas hemorrhagic cysts are very rare. During pregnancy, hemorrhagic cysts may be occured due to blunt trauma such as motor vehicle accidents, accidental falls, and violence. Forthyone-day-old girl was admitted to our clinic with an intraabdominal cyst located in the right ovarian region; which was detected by antenatal ultrasonography,. The postnatal MRI revealed a heterogeneous cystic mass (50x30x30 mm) located in the pelvis. Her mother was exposed to blunt abdominal trauma as domestic violence at her 5th gestational month. The mass was easily removed since it just had a little connection to the mesentery of descending colon. It was thought that the hematoma on the mesentery of colon caused by the maternal trauma. Both ovaries and kidneys had normal appearance. Fortunately, the hematoma did not impair vascularization of the colon or other intraabdominal organs and it only turned into a simple hemorrhagic cyst. The histopathologic examination of the mass was reported as a hemorrhagic and necrotic simple cyst.Ultrasonography is the method of choice for fetal masses during antenatal period. These masses may need to be evaluated by the abdominal MRI after delivery. Some fetal masses may be associated with blunt trauma during pregnancy as seen in our case. Consequently, the medical history of the mother should be carefully obtained in terms of trauma and domestic violence. To the best of our knowledge, neonatal hemorrhagic cyst due to antenatal blunt trauma was not reported in the literature so far

Keywords

• Intrauterine, trauma, hemorrhagic cyst, domestic violence

References

1. Khong PL, Cheung SCW, Leong LLY, Ooi CG. Ultrasonography of Intra-abdominal cystic lesions in the newborn. Clin Radiol 2003;58(6):449-54.
2. Cohen HL, Shapiro MA, Mandel FS, Shapiro ML. Normal ovaries in neonates and infants: a sonographic study of 77 patients 1 day to 24 months old. AJR Am J Roentgenol 1993;160(3):583-6.
3. Carroll BA, Moskowitz PS. Sonographic diagnosis of neonatal me- conium cyst. AJR Am J Roentgenol 1981;137(6):1262-4.
4. Kolawole TM, Bankole MA, Olurin EO, Familusi JB. Meconi- um peritonitis presenting as giant cysts in neonates. Br J Radiol 1973;46(551):964-7.
5. Lin JI, Fisher J, Caty MG. Newborn intraabdominal cystic lym- phatic malformations. Semin Pediatr Surg 2000;9(3):141-5.
6. Lee HC, Yeung CY, Chang PY, Sheu JC, Wang NL. Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance. J Ultrasound Med 2000;19(3):177-82.
7. Warner MW, Salfinger SG, Rao S, Magann EF, Hall JC. Manage- ment of trauma during pregnancy. ANZ J Surg 2004;74(3):125-8.
8. Curet MJ, Schermer CR, Demarest GB, Bieneik EJ 3rd, Curet LB. Predictors of outcome in trauma during pregnancy: identification of patients who can be monitored for less than 6 hours. J Trauma 2000;49(1):18-25.

9. Shah KH, Simons RK, Holbrook T, Holbrook T, Fortlage D, Winchell RJ, et al. Trauma in pregnancy: maternal and fetal out- comes. J Trauma 1998;45:83-6.
10. Fildes J, Reed L, Jones N, Martin M, Barrett J. Trauma: the leading cause of maternal death. J Trauma 1992;32(5):643-5.
11. Redkar R, Davenport M, Howard ER. Antenatal diagno- sis of congenital anomalies of the biliary tract. J Pediatr Surg 1998;33(5):700-4.
12. Kumar HR, Sandoval JA, Lovell MA, Fenton LZ, Bealer JF. Pri- mary pancreatic neuroblastoma: an unusual tumor in infancy. J Pe- diatr Surg 2010;45(3):642-6.
13. Marcolongo A, Divirgilio G, Bettili G, Saverio Camoglio F, Fa- soli L, Marradi P, et al. Immature mesenteric termatoma in a male newborn infant: prenatal ultrasonographic diagnosis and surgical treatment. Prenat Diagn 1997;17(7):686-8.
14. Dunlap JP, James CA, Maxson RT, Bell JM, Wagner CW. Gastric ter- atoma with intramural extension. Pediatr Radiol 1995;25(5):383-4.
15. Khadaroo RG, Evans MG, Honore LH, Bhargava R, Phillipos E. Fetus-in-fetu presenting as cystic meconium peritonitis: di- agnosis, pathology, and surgicalmanagement. J Pediatr Surg 2000;35(5):721-3.
16. Pearlman MD. Motor vehicle crashes, pregnancy loss and pre-term labor. Int J Gynecol Obstet 1997;57(2):127-32.
17. Pearlman MD, Tintinalli JE, Lorenz RP. Blunt trauma during preg- nancy. N Engl J Med 1990;323(23):1609-13.
18. Datner EM, Ferroggiaro AA. Violence during pregnancy. Emerg Med Clin North Am 1999;17(3) 645-56.
19. Goodwin TM, Breen MT. Pregnancy outcome and fetomaternal hemorrhage after noncatastrophic trauma. Am J Obstet Gynecol 1990;162(3):665-71.