Mass Lower Abdomen (Differential Diagnosis Appendicitis/´Surgical Abdomen´/ Abdominal Tumor)

Lower abdomen laparotomy in a 12-year-old girl with 'surgical abdomen'. The surgeon's left hand is holding a large mass with a smooth, regularly discolored and undamaged wall. The view from the bottom shows on the right side a reddish appendage and on the left side at the bottom a rounded and white structure the size of an olive. The diagnosis is a large teratoma adultum which lies at the site of the right ovary and is closely connected with the fallopian tube. On the left side at the bottom in the operating field there is a macroscopically normal left ovary. In this case the leading symptom was a visible and palpable abdominal tumor. The case report illustrates clearly that every ovary with an abnormally large volume is prone to a torsion by the narrow stalk of the ovarian ligament or of the mesentery of the fallopian tube; in this case the clinical manifestation is 'surgical abdomen'. In childhood up to 25 % of all ovarian cysts and tumors manifest due to torsion, bleeding, or rupture as abdominal emergency.