A case of successful laparoscopic surgery for chemical panperitonitis following a spontaneous rupture of the ovarian dermoid cyst

Abstract

We present a case of a 65-year-old woman with chemical panperitonitis following a rupture of the ovarian dermoid cyst, which was successfully treated through laparoscopic surgery. She was referred to our hospital with a large pelvic mass demonstrated in CT scan. Prior to the referral she had complaints of a decrease in urine amount, distended abdomen and high fever.Laboratory data revealed a high inflammatory reaction (WBC count 9100/μl, CRP 20.01mg/dl) and elevated tumor markers (CA125: 47.4U/ml, CA19-9: >12000U/ml). It was confirmed by UST that there was a pelvic cystic mass in the left lower quadrant with a large amount of ascites. MRI findings showed the pelvic cystic tumor to have characteristic features suggestive of the benign ovarian dermoid cyst. It was suggested that the left ovarian dermoid cyst was exacerbated by pelvic inflammatory disease. After the admission she was treated with intravenous antibiotics. The inflammatory condition improved after the conservative therapy. We decided to perform a laparoscopic surgery to remove the mass in 60 days after the appearance of the first symptoms. Using a 9th intercostal space approach with 3mm scope, it was shown that there were various dense adhesions between the intestines and the parietal peritoneum. Proceeding catiously with adhesiolysis, the pelvic cavity was finally outlined. Left adnexectomy was performed and multiple peritoneal drainages were inserted into the peritoneal cavities. From the laparoscopic findings and the histological examination, the final diagnosis was chemical panperitonitis following a spontaneous rupture of the ovarian dermoid cyst. We reported a successful laparoscopic intervention in the chemical peritonitis, even though it involved a great amount of difficulties in the operative procedures.