Abstract
Mature cystic teratoma (MCT) is a common benign ovarian germ cell tumor. It is more predominantly seen in premenopausal women and contains at least two or more well-differentiated germ cell layers. It is termed a dermoid cyst if the ectodermal tissue is the predominant component. The complications of a dermoid cyst include torsion, malignant degeneration, rupture, and infection. The incidence of a ruptured dermoid cyst is around 1%-2% resulting in chemical aseptic peritonitis from spillage of the cyst contents. Usual clinical presentation is with diffuse abdominal or pelvic pain and abdominal distension. Around 93-96% of dermoid cysts demonstrate fat in the cyst cavity however, minimal or no fat poses diagnostic challenges. In this case, we discuss a rare case of spontaneously ruptured lipid-poor and thyroid tissue-rich left ovarian dermoid presenting with chemical peritonitis. Special magnetic resonance (MR) Imaging sequences such as fat saturation imaging, chemical shift imaging, and gradient-echo imaging assist in detecting scant amounts of fat in the cyst cavity or cyst wall.
Highlights
Categories: Emergency Medicine, Obstetrics/Gynecology, Radiology Keywords: dermoid cyst, lipid poor dermoid, mature cystic teratoma, chemical peritonitis, struma ovarii, mri Teratomas are the most common ovarian germ cell tumors which arise from primitive germ cells [1]
We present a 33-year-old female with sudden onset of abdominal pain diagnosed as chemical peritonitis secondary to spontaneous rupture of lipid-poor ovarian dermoid cyst
Upon discovery of a complex mass further evaluation should be done with a pelvic magnetic resonance imaging (MRI) with IV contrast
Summary
Teratomas are the most common ovarian germ cell tumors which arise from primitive germ cells [1]. Detection of chemical peritonitis may pose a diagnostic challenge especially if the cyst has a poor macroscopic fat content. In this case report, we present a 33-year-old female with sudden onset of abdominal pain diagnosed as chemical peritonitis secondary to spontaneous rupture of lipid-poor ovarian dermoid cyst. The patient reported worsening pain with movement, which gets relieved by lying still She reported a progressive increase in abdominal girth over the past several weeks. Intraoperative findings revealed a ruptured left ovarian cyst on the inferior aspect emanating serous fluid into the peritoneal cavity.
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