From the Guidelines
The correct answer is B. Go and get a written consent from her father. When an unexpected finding like an ovarian cyst is discovered during an appendectomy in a minor, the surgeon should obtain specific informed consent before performing additional procedures beyond the original scope. Even though removing the cyst might prevent future surgery, proceeding without consent would be unethical and potentially illegal. The patient is a minor, so consent must come from her parent or legal guardian. While it may seem efficient to address the cyst during the current operation, patient autonomy and informed consent are fundamental ethical principles that must be respected. The family deserves to understand the risks, benefits, and alternatives of the additional procedure before a decision is made. Obtaining proper consent demonstrates respect for patient rights and protects both the patient and the surgeon from potential legal complications. According to the study by Gupta et al 1, the risk of malignancy in simple ovarian cysts is very low, and most simple cysts in premenopausal patients are functional cysts that will resolve on their own. However, this does not justify proceeding with a procedure without proper consent, especially in a minor. The American College of Radiology's O-RADS US risk stratification and management system 1 provides guidelines for managing adnexal masses, but it does not address the issue of informed consent in minors. Therefore, the surgeon should prioritize obtaining proper consent before proceeding with any additional procedures. In this case, the surgeon should go and get a written consent from her father before deciding on the best course of action for the ovarian cyst. This approach ensures that the patient's rights are respected, and the surgeon is protected from potential legal complications. It also allows the family to make an informed decision about the additional procedure, taking into account the risks, benefits, and alternatives. Ultimately, prioritizing informed consent is essential in this scenario, as it is a fundamental ethical principle in medical practice.
From the Research
Considerations for Ovarian Cyst Discovery During Appendectomy
- The discovery of a simple ovarian cyst during an appendectomy in a 12-year-old female raises questions about the best course of action, considering the need for informed consent and the potential benefits of addressing the cyst to prevent future complications 2, 3.
- Studies have shown that ovarian cysts can be a common finding in females undergoing appendectomy, and that addressing these cysts during the same procedure can be beneficial in preventing future surgeries and complications 4, 5.
- However, the principle of autonomy and informed consent is crucial in such situations, and obtaining consent from the patient's guardian is essential before proceeding with any additional procedures 6.
- The decision to address the ovarian cyst during the appendectomy should be made on a case-by-case basis, taking into account the patient's best interests, the potential risks and benefits of the procedure, and the need for informed consent.
Potential Courses of Action
- Leaving the cyst untreated without consent may not be the best option, as it may lead to future complications and the need for additional surgeries 3.
- Obtaining written consent from the patient's guardian before proceeding with the procedure is essential to ensure that the patient's autonomy is respected and that the guardian is fully informed of the potential risks and benefits 6.
- Consulting with another colleague or seeking a second opinion may be beneficial in determining the best course of action, but ultimately, the decision should be made in the patient's best interests and with the necessary consent 2, 4.
- Proceeding with the procedure without consent is not a viable option, as it would violate the principle of autonomy and informed consent 6.