8482 An Unusual Presentation of Granulomatous Peritonitis Following Cystectomy for Mature Teratoma

Abstract

<h3>Study Objective</h3> To highlight granulomatous peritonitis as a potential complication of cyst content spillage during laparoscopic ovarian cystectomy for mature teratoma. To describe the first known case of granulomatous peritonitis infiltrating the right hemidiaphragm, leading to right-sided pneumonia and requiring a partial diaphragmatic resection. To review prevention and treatment strategies of granulomatous peritonitis following ovarian cystectomy for mature cystic teratoma. <h3>Design</h3> Case report. <h3>Setting</h3> Community hospital. <h3>Patients or Participants</h3> 1 patient. <h3>Interventions</h3> Surgical intervention consisting of extensive resection of disease, including laparoscopy converted to midline laparotomy, left salpingo-oopherectomy, omentectomy, partial bladder cystectomy, liver wedge resection, diaphragm stripping, partial resection of diaphragm, mesenteric nodule resection, appendectomy, repair of both large and small bowel; as well as resection of anterior abdominal wall disease. <h3>Measurements and Main Results</h3> Pathology demonstrated recurrent mature cystic teratoma, abundant hair fragments and associated foreign body type granulomatous reaction. The patient was asymptomatic at 9 months after surgical intervention. <h3>Conclusion</h3> Awareness of granulomatous peritonitis, and the potential extent of disease, as a complication of dermoid cyst rupture is paramount. Cyst content spillage is often challenging to avoid, and copious irrigation is advised if spillage occurs - yet may still not successfully prevent peritonitis. Route of cystectomy should be carefully considered to minimize risk of spillage. Ultimately, maintaining an index of suspicion for this diagnosis when a patient presents with vague or unusual symptoms following laparoscopic cystectomy for mature dermoid may expedite appropriate care, which may include extensive surgical resection.