This guideline does not apply to cystic structures which may be arising from the urinary tract

• Antenatally detected intra-abdominal cysts include:
  
  • ovarian
  • intestinal duplication 
  • mesenteric 
  • vitello-intestinal 

• Most cysts will be asymptomatic but the following can be present:
  
  • abdominal pain
  • vomiting
  • abdominal distension
  • respiratory compromise
  • rectal bleeding
• Meconium pseudocyst may also be detected on an antenatal ultrasound. They will nearly always cause vomiting and abdominal distension and may be associated with underlying diagnosis of cystic fibrosis

Antenatal

• Refer to/discuss appropriate place for delivery with fetal medicine unit
• Refer to paediatric surgeon for antenatal counselling

Delivery

• In most cases, obstetric management will not alter 

Postnatal

• Resuscitate baby as normal 
• Once stable, perform full postnatal physical examination (see Examination of the newborn guideline)

Meconium pseudocyst

• If suspected antenatally, do not feed baby at birth
• Insert size 8 Fr nasogastric tube (NGT) immediately after birth and fix securely with tape (see Nasogastric tube insertion guideline)
• Empty stomach by aspirating NGT with a 10 or 20 mL syringe 
  
  • if <20 mL aspirated, check position of tube
• Place NGT on free drainage by connecting to a bile bag
• Once stabilised, admit baby to NNU
• Replace nasogastric losses, mL-for-mL, using sodium chloride 0.9% with potassium chloride 10 mmol/500 mL IV
• Commence IV maintenance fluids (see Intravenous fluid therapy guideline)
• On day of birth, refer to on-call surgical team at planned place of surgery

Other types of intra-abdominal cyst

• Unless significant abdominal distension present following birth, allow baby to feed normally and observe in postnatal ward for ≥48 hr 
• If baby well after 48 hr with no abdominal symptoms and feeding normally then discharge
• Arrange outpatient abdominal ultrasound scan ≤1 week of birth
• Consider sacrococcygeal teratoma (SCT) – could be entirely intra-abdominal and arising from pelvis, in which case discuss with paediatric surgeon

• Urgency will depend on clinical situation
• Meconium pseudocyst:
  
  • manage as above and refer to surgeon on day of birth
• Symptomatic cyst: 
  
  • stabilise on NNU and refer to on-call surgical team on day of presentation
• Asymptomatic cyst: 
  
  • abdominal ultrasound ≤1 week of birth
  • when result known, written outpatient referral to consultant paediatric surgeon
  • if arising from pelvis consider SCT and discuss with paediatric surgeon 
• Resolved cyst:
  
  • ultrasound ≤1 week of birth, even if cyst appears to have resolved during pregnancy. Arrange outpatient surgical referral

• http://www.e-lfh.org.uk/programmes/paediatric-surgery/