Abdominal Tumor (Differential Diagnosis as before)

abdo_14a_n.jpg to abdo_14d_n.jpg: Lower abdominal laparotomy in a 9-year-old girl with abdominal tumor. abdo_14a_n.jpg: After spreading of the rectus muscles which have been incised in a longitudinal direction a large mass becomes visible measuring 9 to 10 cm. This mass is in its lower part brownish discolored and in its upper part covered by the omentum. abdo_14b_n.jpg: The mass is luxated out of the original site in the pelvis. Underneath there is a finger-like structure of the same color, and in continuation with it a triangular organ of vital color. abdo_14c_n.jpg: Displacement of the mass to the right side. On the left side a white-bluish structure the size of a plum is visible. abdo_14d_n.jpg: The mass after excision. abdo_14a_n.jpg to abdo_14d_n.jpg: The cause of the clinical presentation 'abdominal tumor' or 'surgical abdomen' is a torsion of a large ovarian cyst. The torsion reaches the transition of the right fallopian tube to the uterus and has led to necrosis of the right ovary and fallopian tube. The uterus - in abdo_14b_n.jpg and in abdo_14c_n.jpg recognizable - has a normal blood supply. The left ovary in abdo_14c_n.jpg is too large for the age. In case of torsion of an ovarian cyst or tumor a mass is palpable on rectal or rectoabdominal examination ($$abdo_10??££compare§§). In a late stage the symptoms and signs (fever, mass in the lower abdomen and pelvis, peritonism) may also be reminiscent of a perityphlitic abscess.