Ruptured ovarian cystic teratoma in pregnancy with diffuse peritoneal reaction mimicking advanced ovarian malignancy: a case report

Sachchidananda Maiti,Re Hopkins,Zamurrad Fatima,Zk Anjum

doi:10.1186/1752-1947-2-203

Sachchidananda Maiti, Re Hopkins + Show 2 more

Open Access

https://doi.org/10.1186/1752-1947-2-203

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Abstract

IntroductionThis case illustrates the unusual complication of granulomatous peritonitis following rupture of a dermoid cyst in pregnancy resembling disseminated ovarian carcinoma. To the best of the authors' knowledge, this is the first report of this complication during advanced pregnancy in the literature.Case presentationA dermoid cyst ruptured during surgical removal in the second trimester of pregnancy in a 27-year-old primigravida. Postoperatively the patient suffered pulmonary embolism and leakage of sebaceous material through the abdominal wound. She gradually developed significant abdominal distension, gastrointestinal symptoms and lost more than 8 kg of weight in the 12 weeks postoperatively. The baby was delivered at 31 weeks by a technically challenging caesarean section owing to severe dense adhesions obscuring the uterus. Bowel resection was performed for suspected malignant infiltration and adhesion causing obstruction. She had a protracted convalescence with an ileostomy and mucus fistula. Histology confirmed granulation without malignancy. One year following the surgical treatment, she had recovered well and was planning her next pregnancy.ConclusionAlthough granulomatous peritonitis following rupture of a dermoid cyst is very rare, awareness is the key to diagnosis and appropriate management. Per-operative frozen section may be helpful.

Highlights

This case illustrates the unusual complication of granulomatous peritonitis following rupture of a dermoid cyst in pregnancy resembling disseminated ovarian carcinoma
Conclusion: granulomatous peritonitis following rupture of a dermoid cyst is very rare, awareness is the key to diagnosis and appropriate management
Mature cystic teratoma is one of the most common benign ovarian neoplasms discovered during pregnancy (24–40%) [1,2]

Summary

Introduction

Mature cystic teratoma (dermoid cyst) is one of the most common benign ovarian neoplasms discovered during pregnancy (24–40%) [1,2]. A booking ultrasound scan at 13 weeks gestation in a 27year-old primigravida showed an 11 × 9 × 10 cm smoothwalled, mixed echogenic mass in the pouch of Douglas (POD) suggesting a dermoid cyst and a viable singleton intra-uterine pregnancy. Bacterial culture was again reported to be negative She developed dependent oedema, abdominal distension, intermittent vomiting and significant weight loss despite advancing pregnancy. In view of the patient's continuing deterioration and significant psychological distress, it was decided to deliver the baby She underwent an elective caesarean section at 31 weeks gestation following a course of antenatal steroids for foetal pulmonary maturation. Histology of the specimen confirmed granulation and inflammation consistent with granulomatous peritonitis without any evidence of malignancy (figure 2) She suffered further wound breakdown and developed a small bowel fistula through the operative wound. She is presently thinking about going back to work and the possibility of conceiving again

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