Prolonged Chemical Peritonitis Following Intraperitoneal Rupture of a Dermoid Cyst

Abstract

Abstract

Background:

Laparoscopic removal of a dermoid cyst carries a small risk of chemical peritonitis if intraoperative spillage of the cyst contents occurs. There are few reported cases of chemical peritonitis after iatrogenic intraperitoneal rupture of a dermoid cyst, and even fewer cases of prolonged chemical peritonitis.

Case:

A 35-year-old woman, G0, underwent laparoscopy for removal of a dermoid cyst. It could not be removed intact due to adhesions. The peritoneal cavity was irrigated before closure. Within days after surgery, the patient began experiencing fever, vomiting, and abdominal discomfort. A computed tomography (CT) scan showed peritonitis with ascites, right basilar pneumonia, and a right ovarian cyst with rim calcification. The patient was treated with intravenous and oral antibiotics. Over the next 2 months, her symptoms recurred, and she had two additional hospitalizations, thoracentesis, paracentesis, CT-guided percutaneous drainage and subsequent catheter repositioning, and two additional courses of antibiotics. Sixty-four days after surgery, she was reexplored laparoscopically to remove the calcified remnant. However, her symptoms persisted for another 2 months until she underwent laparotomy with incision, drainage, and debridement. She required drainage of fluid one last time and, since then, her symptoms resolved.

Results:

This patient had a 6-month course of complications related to chemical peritonitis from iatrogenic rupture of a dermoid cyst.

Conclusions:

Chemical peritonitis following intraoperative rupture of a cyst is a rare but potentially serious and intractable condition. Care should be taken to avoid intraoperative rupture. If rupture occurs, a thorough abdominal washout should be performed. If chemical peritonitis develops, early reoperation may be advantageous, especially if remnants are suspected. (J GYNECOL SURG 33:68)