Persistent chemical peritonitis resulting from spontaneous rupture of an ovarian mature cystic teratoma

Abstract

Spontaneous rupture of mature cystic teratoma occurs rarely, but may lead to a chemical peritonitis. Once rupture of mature cystic teratoma is diagnosed, immediate surgical intervention is necessary. Removal of ruptured ovarian cystic teratoma and copious lavage of abdominal cavity are usually suffi cient to prevent prolonged chemical peritonitis. We report here a rare case of spontaneously ruptured ovarian cystic teratoma diagnosed by computed tomography scan obtained before and after the rupture, and in which chemical peritonitis lasted over 2 months after surgery.Keywords: Mature cystic teratoma; Spontaneous rupture; Chemical peritonitis Received: 2011. 5.30. Revised: 2011. 8. 9. Accepted: 2011 Th is is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2011. Korean Society of Obstetrics and GynecologyMature cystic teratomas are the most common ovarian tumors, accounting for 20% of adult ovarian tumors and 50% of pediatric ovarian tumors. The most frequent complication of an ovarian mature cystic teratoma is torsion, but rupture occurs rarely with an estimated incidence of 0.3-2.5% [1,2]. Its spontaneous or iatrogenic intraperitoneal rupture may lead to a chemical peritonitis. We report a case of intraperitoneal rupture of an ovarian mature cystic teratoma, diagnosed by repeated computed tomography (CT) at short intervals, and resultant chemical peritonitis which persisted for over 2 months after surgery. Case ReportA 50-year-old woman, gravida 3, para 2, presented to our emergency room with several hours history of abdominal pain and nausea. On physical examination, she was afebrile and vital signs were stable. Abdominal examination revealed mild tenderness in lower abdomen. No obvious muscle guarding or rebound tenderness was noted. Total white blood cell count was 12,980/mm 3 and C-reactive protein (CRP) was 12.9 mg/dL. Abdominal CT scan showed cystic mass measuring 4.2 cm in maximal diameter with fat-fl uid level in left adnexa, suggestive of a cystic teratoma, and small amount of ascites in pelvic cavity (Fig. 1A). No other abnormalities suspicious of torsion or rupture of a cystic teratoma were found. Diagnostic laparoscopy had been recommended for further evaluation, but she signed herself out of the hospital against medical advice for personal reasons. Two days later, she readmitted to the emergency room with progressively worsening abdominal pain. Physical examination revealed a distended abdomen with marked tenderness and rebound tenderness in the lower abdomen. The body temperature was elevated to 38.8 o C.The serum CRP rose to 33.4 mg/dL. Serum CA 19-9 was 75.6 U/ CASE REPORT Korean J Obstet Gynecol 2011;54(11):726-730 http://dx

Ruptured dermoid cyst of ovary developing into chronic peritonitis; a rare complication diagnosed by contrast CT: A case study

“…After the rupture of the dermoid cyst, the release of tumor contents can cause peritonitis. The presentation can be acute or chronic [ 1 ]. [ 2 ].…”

“…Among the tumors of the germ cell derivatives of the ovary, dermoid/mature cystic teratoma is the most common variant that accounts for 20% of all adult ovarian tumors[ 1 ]. [ 2 ].…”

Peritonitis From Ruptured Lipid-Poor Dermoid: Struma Ovarii

“…This rupture may occur abruptly or chronically due to minor tears in the cyst wall [ 10 ], our patient did not report trauma but presented with subacute symptoms over a few days. The manifestations of either acute or chronic include ascites and inflammatory nodules involving omentum and peritoneum mimicking peritoneal carcinomatosis or tuberculous peritonitis [ 11 ]. In the present case, there was a smooth enhancement of the peritoneum without nodularity as in Figure 7 which can be explained by more serous content of the dermoid cyst.…”

Spontaneously Ruptured Dermoid Cysts and Their Potential Complications: A Review of the Literature with a Case Report

“…Medical imaging has difficulty in detecting a ruptured dermoid cyst, particularly at the time of rupture. This is especially the case when rupture signs may be subtle as a small cyst wall discontinuity or insidious leakage of cyst contents [19,20]. The best and most common imaging modality used to detect unruptured dermoid cysts is a transvaginal ultrasound, with studies showing a 99% specificity and 58% sensitivity [8].…”

“…Number 5 Case Reports in Obstetrics and Gynecology presenting as omental infiltration, perilesional fat stranding, fatty fluid in the peritoneal cavity, and intraperitoneal fat implants around the flat surface of the bowel, liver, omentum, and peritoneum [8,19,20]. These are all characteristic features of a ruptured dermoid cyst and chemical peritonitis.…”