Korean J Obstet Gynecol.  2011 Nov;54(11):726-730. 10.5468/KJOG.2011.54.11.726.

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

• Yang HS
• Song TH
• Bang HC
• Park JH
• Lee CH
• Roh JW
• Kim EJ
• Lee YS
• Han SS

• KMID: 2274115
• DOI: http://doi.org/10.5468/KJOG.2011.54.11.726

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 sufficient 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.

Keyword

Mature cystic teratoma; Spontaneous rupture; Chemical peritonitis

MeSH Terms

Abdominal Cavity
Female
Ovarian Cysts
Peritonitis
Rupture
Rupture, Spontaneous
Teratoma
Therapeutic Irrigation

Figure

• 

  Fig. 1 (A) Computed tomography (CT) scan shows a left ovarian mass (arrow) with fat-fluid level with small amount of ascites. (B) CT scan after rupture shows a left ovarian mass (arrow) surrounded by fat globules, decreased amount of fat component within the cyst, thickening of peritoneum, diffuse wall thickening of small bowels, and increased amount of ascites.

• 

  Fig. 2 Intraoperative laparoscopic finding shows left ovarian cyst. The peritoneum, uterus, and bowel surfaces are covered by diffuse, thick, white to yellowish plaque-like lesion.

Reference

1. Iwata A, Matsubara K, Umemoto Y, Hashimoto K, Fukaya T. Spontaneous rupture of benign ovarian cystic teratoma in a premenarcheal girl. J Pediatr Adolesc Gynecol. 2009. 22:e121–e123.

2. Peterson WF, Prevost EC, Edmunds FT, Hundley JM Jr, Morris FK. Benign cystic teratomas of the ovary; a clinico-statistical study of 1,007 cases with a review of the literature. Am J Obstet Gynecol. 1955. 70:368–382.

3. Fibus TF. Intraperitoneal rupture of a benign cystic ovarian teratoma: findings at CT and MR imaging. AJR Am J Roentgenol. 2000. 174:261–262.

4. Phupong V, Sueblinvong T, Triratanachat S. Ovarian teratoma with diffused peritoneal reactions mimicking advanced ovarian malignancy. Arch Gynecol Obstet. 2004. 270:189–191.

5. Quer EA, Dockerty MB, Mayo CW. Ruptured dermoid cyst of the ovary simulating abdominal carcinomatosis; report of case. Proc Staff Meet Mayo Clin. 1951. 26:489–498.

6. Chang YT, Lin JY. Intraperitoneal rupture of mature cystic ovarian teratoma secondary to sit-ups. J Formos Med Assoc. 2009. 108:173–175.

7. Bhatla N, Khanna R, Bhargava VL. Intraperitoneal rupture of benign cystic teratoma. Int J Gynaecol Obstet. 1993. 40:163–164.

8. Suprasert P, Khunamornpong S, Siriaunkgul S, Phongnarisorn C, Siriaree S. Ruptured mature cystic teratomas mimicking advanced stage ovarian cancer: a report of 2 cases study. J Med Assoc Thai. 2004. 87:1522–1525.

9. Park SB, Kim JK, Kim KR, Cho KS. Imaging findings of complications and unusual manifestations of ovarian teratomas. Radiographics. 2008. 28:969–983.

10. Nitinavakarn B, Prasertjaroensook V, Kularkaew C. Spontaneous rupture of an ovarian dermoid cyst associated with intra-abdominal chemical peritonitis: characteristic CT findings and literature review. J Med Assoc Thai. 2006. 89:513–517.

11. Achtari C, Genolet PM, Bouzourene H, De Grandi P. Chemical peritonitis after iatrogenic rupture of a dermoid cyst of the ovary treated by coelioscopy. Apropos of a case and review of the literature. Gynakol Geburtshilfliche Rundsch. 1998. 38:146–150.

12. Clement D, Barranger E, Benchimol Y, Uzan S. Chemical peritonitis: a rare complication of an iatrogenic ovarian dermoid cyst rupture. Surg Endosc. 2003. 17:658.

13. Rubod C, Triboulet JP, Vinatier D. Ovarian dermoid cyst complicated by chemical peritonitis: case report. Gynecol Obstet Fertil. 2007. 35:651–653.

14. Koshiba H. Severe chemical peritonitis caused by spontaneous rupture of an ovarian mature cystic teratoma: a case report. J Reprod Med. 2007. 52:965–967.

15. Stuart GC, Smith JP. Ruptured benign cystic teratomas mimicking gynecologic malignancy. Gynecol Oncol. 1983. 16:139–143.