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Background: Mature cystic teratoma (MCT) comprises 95% of ovarian germ cell tumors with 10-25% incidence in adults. The sequelae include torsion (15%), malignant transformation (1-2%), infection (1%), and rupture (0.3-2%). Spontaneous ruptures of MCT with spillage of sebaceous material into the abdominal cavity are rare due to its thick capsules. Ruptured ovarian teratoma can lead to chemical peritonitis, which is uncommon with diverse presentations. It presents with contralateral abdominal pain due to spillage of its contents into the opposite side of the abdominal cavity following tumor rupture. Case description: This is an unusual presentation of twisted and ruptured ovarian teratoma. A 26-year-old para 1 presented with persistent left lower abdominal pain that radiated to right and sought treatment from various clinics for a week duration. She was referred to a tertiary hospital for ruling out acute appendicitis for right-sided lower abdominal pain where the appendix is located. At first, she presented with sudden onset of moderate-to-severe left iliac fossa (LIF) pain during a bowel opening 5 days ago. Subsequently, the pain radiated to the right iliac fossa (RIF) and worsened on the day of admission. She also had multiple episodes of vomiting and vague suprapubic mass for 1 week. Abdominal examination revealed a palpable cystic suprapubic mass which is about 10 × 8 cm with persistent RIF pain. Ultrasonography showed a solid cystic mass at the LIF measured about 11 × 6 cm and the right ovary was visualized, with normal size uterus and thin endometrial lining. There was significant amount of free fluid, with normal kidneys seen. Ultrasound examination provided an inconclusive diagnosis and an emergency laparotomy was performed for suspicion of a ruptured ovarian cyst with a differential diagnosis of a perforated appendix. There was a twisted and ruptured left ovarian teratoma with a gangrenous base found intraoperatively which contains sebum, hair, and slough at the anterior part of the uterus and thicken omentum. Left-sided salpingo-oophorectomy and omentectomy were done. The peritoneal cavity was washed with copious amounts of warm saline. Conclusion: A ruptured dermoid cyst is one of the gynecological emergencies but is often an overlooked diagnosis. Mature ovarian teratoma consists of well-differentiated germ cell layers derivatives developing as hair, muscle, teeth, or bone. The size of dermoid cysts and torsion with infarction can contribute to their rupture. Correct diagnosis and timely surgical intervention are essential for preventing chemical peritonitis, long-term sequelae, and conserving the reproductive function. [ABSTRACT FROM AUTHOR]

Mature cystic teratoma (MCT) is the most common tumour of the ovary and includes at least two well-differentiated germ cell layers. The incidence is higher in reproductive age group and rarely among postmenopausal age women. It is benign condition however associated with multiple complication such as torsion, ruptured and chemical peritonitis. As it is rare among postmenopausal age group, it can be presented as chronic ovarian mass with expected complication and possibility of malignant transformation. Thorough assessment with adjunct of radiological imaging may assist in diagnosis and further management. Radiological imaging modalities were sensitive and sensitive in diagnosis of MCT however there were low specificity in detection of complication. Management of MCT in postmenopausal women mandate thorough evaluation considering the risk of malignant transformation and associated complications. [ABSTRACT FROM AUTHOR]

Objective: The most-dreaded complications of dermoid cyst spills are chemical peritonitis, iatrogenic implantation of malignant cells, and recurrences. This study recorded the incidence of chemical peritonitis after dermoid-cyst excision with intraoperative cyst spilling and examined short- and long-term postoperative complications and recurrence rates. Materials and Methods: This retrospective analysis included 72 females who underwent ovarian cystectomies and who had ovarian dermoid cysts excisions from January 2016 to December 2020. Data pertaining to types of procedures, intraoperative cyst ruptures, chemical peritonitis, readmissions, and recurrences were analyzed. Results: Females (72) underwent dermoid-cyst excisions (laparotomy: 12; laparoscopy: 60). The mean age of presentation was 29.3 ± 11 years, mean cyst volume was 488.08 ± 1852.8 cc; 88.9% of cysts ruptured during excision; 0 cases of chemical peritonitis; and 1 patient had a cyst recur 4 months after removal. The laparotomy group, had a higher incidence of raised cancer antigen–125 levels (p < 0.001), torsions (p < 0.05), salpingo-oophorectomies (p < 0.001), estimated blood losses (p < 0.003), and longer operative times (p < 0.002), compared to the laparoscopy group. However, there was no significant difference between the 2 groups in spillages, chemical peritonitis, postoperative complications, and recurrences. In a subgroup analysis of laparoscopy cases, spillage was commonly associated with larger cysts (p < 0.0001), cystectomies (p < 0.0001), and longer operative times (p < 0.06). Conclusions: Intraoperative cyst content spillage does not influence the outcome of dermoid-cyst removal. Hence, laparoscopy is a safe and effective method of managing dermoid cysts. (J GYNECOL SURG 38:221) [ABSTRACT FROM AUTHOR]

Objective: To review short- and long-term complications associated with intraoperative rupture of benign ovarian cysts.Data Sources: The Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched using the following terms and their combinations: "spillage," "rupture," "leakage," "ovarian cyst," "teratoma," "dermoid," "operative," "surgery," "outcome."Methods Of Study Selection: Randomized controlled and observational studies evaluating the operative outcomes of surgical treatment of ovarian cysts with intraoperative spillage compared with those of surgical treatment of ovarian cysts without spillage were included. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed.Tabulation, Integration, and Results: A total of 28 studies were included in the qualitative analysis and 12 in the quantitative analysis. Ovarian cyst diameter was not found to be associated with the risk for spillage (relative risk [RR] 0.75; 95% confidence interval [CI], -0.33 to 1.82). Intraoperative benign ovarian cyst rupture was not associated with adverse short- and long-term outcomes such as reoperation (RR 1.16; 95% CI, 0.39-3.48), infertility (RR 0.73; 95% CI, 0.15-3.63), transient fever (RR 3.22; 95% CI, 0.83-12.51), and readmission (RR 1.00; 95% CI, 0.33-2.98). However, intraoperative spillage was found to be associated with increased risk for benign recurrence (RR 3.1; 95% CI, 1.05-9.14). A subgroup analysis of the studies that included only dermoid cysts showed an association between intraoperative cyst rupture and postoperative chemical peritonitis (RR 9.36; 95% CI, 1.20-73.28).Conclusion: Intraoperative ovarian cyst spillage of a benign cyst is associated with limited adverse clinical outcomes. Although the surgical approach (minimally invasive vs open) should not be affected by the concern regarding an intraoperative cyst rupture, maximal efforts should be made to prevent intra-abdominal spillage. [ABSTRACT FROM AUTHOR]

One of the most common benign tumors in reproductive age women is mature Teratoma. We reported a 35 years old woman who presented with abdominal pain, nausea, vomiting and fever. The patient underwent laparotomy with the probable diagnosis of ovarian torsion. The evidence in the peritoneal cavity revealed chemical peritonitis due to spontaneous ruptured of dermoid cyst.

Background. Mature cystic teratomas (dermoid cysts) are the most common germ cell tumours with 10–25% incidence of adult and 50% of paediatric ovarian tumours. The aetiology of dermoid cysts is still unclear, although currently the parthenogenic theory is most widely accepted. The tumour is slow-growing and in the majority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. The main complication of a dermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1–2%), infection (1%), and rupture (0.3–2%). Prolonged pressure during pregnancy, torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. The diagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. Materials and methods. We present a report of a clinical case of a 35-years-old female, who was referred to the hospital due to abdominal pain spreading to her feet for three successive days. She had a history of a normal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed a multiloculated cystic mass measuring 16 × 10 cm in the pelvis. In the absence of urgency, planned surgical treatment was recommended. The next day the patient was referred to the hospital again, with a complaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. The ultrasound scan differed from the previous one. This time, the transvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was a large amount of free fluid in the abdominal cavity. The patient was operated on – left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of the thromboembolism were administered. The patient was discharged from the hospital on the seventh postoperative day and was sent for outpatient observation. Results and conclusions. Ultrasound is the imaging modality of choice for a dermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once a rupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of the spontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.

One of the most common benign tumors in reproductive age women is mature Teratoma. We reported a 35-year-old woman who presented with abdominal pain, nausea, vomiting, and fever. The patient underwent laparotomy with the probable diagnosis of ovarian torsion. The evidence in the peritoneal cavity revealed chemical peritonitis due to the spontaneous rupture of the dermoid cyst. [ABSTRACT FROM AUTHOR]

Study Objective (1) To determine the incidence of chemical peritonitis after cystectomy for ovarian dermoid cysts with intraoperative cyst rupture in the pediatric and adolescent population; and (2) to examine the intraoperative and postoperative outcomes of cystectomies performed for ovarian dermoid cysts using laparoscopy and laparotomy, especially those with intraoperative cyst rupture. Design A retrospective cohort study of female patients who underwent ovarian cystectomy with proven ovarian dermoid pathology between July 2007 and July 2015. Setting Texas Children's Hospital, Houston, Texas. Participants One hundred forty-four patients between the ages of 1 and 21 years who underwent an ovarian cystectomy with proven benign ovarian dermoid histology on the basis of pathology reports. Interventions and Main Outcome Measures Occurrence of spill of cyst contents, chemical peritonitis, postoperative complications, and hospital readmissions. Results One hundred forty-four female patients underwent cystectomy (38 laparotomy and 106 laparoscopy) resulting in benign ovarian dermoid histology. Their mean age was 12.4 ± 4.1 years (range, 1-21), mean cyst size was 9.2 ± 6.4 cm (range, 1-30 cm), no patients had elevated tumor markers, 42 (29.1%) presented with torsion, 73 (50.7%) had cyst fluid spill, and there were no cases of chemical peritonitis. Few significant differences were found between cases performed via laparoscopy and laparotomy and those with and without intraoperative cyst rupture resulting in spill of contents. Laparotomy cases were found to have larger mean cyst size ( P < .001), estimated blood loss ( P = .003), and presence of bilateral cysts ( P = .017) compared with laparoscopic cases. Cyst fluid spill occurred in more laparoscopic cases ([67/106] 63.2% vs [6/38] 15.8%; P < .001), and risk increased with cyst size greater than 5 cm ( P < .001). In the laparoscopy group, cyst size greater than 5 cm was more likely to present with torsion ( P < .001). There was no significant difference in the repeat cystectomy rate between the laparoscopy and laparotomy groups even with cyst rupture ( P = .394). Only 5 cases presented to the emergency room postoperatively and 2 were admitted postoperatively for umbilical port site dehiscence and pyelonephritis. Conclusion Laparoscopic cystectomy of ovarian dermoid cysts is associated with greater intraoperative cyst rupture. However, cyst rupture is rarely associated with complications, therefore minimally invasive surgical management of ovarian dermoid cysts is a reasonable surgical approach. [ABSTRACT FROM AUTHOR]

Objective: To clarify the clinical characteristics and laparoscopic surgical outcomes of dermoid cysts complicated by spontaneous rupture., Methods: This was a single-center retrospective observational study of patients with dermoid cysts treated between January 2005 and December 2021., Results: Among 1205 cases of dermoid cysts, spontaneous rupture occurred in nine and torsion occurred in 83 cases. No obvious triggers for rupture were identified, except for one postpartum case with fundal uterine pressure maneuver. Rupture was identified by computed tomography (CT) in six cases. Patients with ruptured cysts had significantly higher serum C-reactive protein (CRP), cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma antigen (SCC) levels compared with patients with uncomplicated dermoid cysts or cysts with torsion. Laparoscopic management was possible except for one case with severe adhesion, which required laparotomy. Two patients required prolonged postoperative administration of antibiotics due to refractory chemical peritonitis., Conclusion: Combined use of CT imaging and elevated levels of CRP, CA125, CA19-9, and SCC may help to differentiate cyst rupture from torsion. Laparoscopic surgery may be a feasible option; however, prompt laparotomic conversion should be considered in cases with difficult adhesiolysis. Refractory chemical peritonitis may occur after successful surgical management.

Benign cystic ovarian teratoma is the most common ovarian neoplasm accounting for 10-25% of ovarian tumors.They affect women of all age and particularly women of reproductive age group.They may present with a variety of symptoms ranging from being asymptomatic to pain abdomen, dysmenorrhea, pelvic pain, nausea, vomiting, fever, anorexia, loss of weight and shortness of breath. The complications associated with benign cystic teratoma are torsion (16%), malignant degeneration (2%), rupture (1-2%), and infection (1%). Its spontaneous or iatrogenic intraperitoneal rupture is associated with chemical peritonitis. A dermoid cyst has been associated with thrombocytosis in 30% of the cases. Hereby we present a case of huge ovarian dermoid cyst associated with thrombocytosis and spontaneous preoperative rupture with chemical peritonitis.

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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) [ABSTRACT FROM AUTHOR]

Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of ovarian dermoid cysts in selected cases. The aim of this study was to analyze the safety of laparoscopy in ovarian dermoid cysts treatment and risk of chemical peritonitis. We report 63 cases of patients (mean age of 37) with ovarian dermoid cysts originating from the ovary, treated from 2002 to 2010. Most of the patients underwent cysts removal. In 7 patients salpingo-oophorectomy was performed. We used 15 mm trocars for removing specimens. In patients with dermoid cyst rupture peritoneal cavity was washed out thoroughly with Ringer lactate and drained for 24-48 hours. All the material extracted was sent for a histopathology examination. The diagnosis of mature ovarian dermoid cysts was confirmed in 58 (92.63%) of cases and immature ovarian dermoid cysts in 5 (7.37%) cases. Dermoid cysts were composed of tissue developed from three germinative layers in 31 (49%) patients, from two germinative layers in 25 (40%), and in 7 (11%) patients from one germinative layer. No intra or postoperative complications occurred. No signs or symptoms of chemical peritonitis were observed regardless of cystic spillage or not. We conclude that the risk of chemical peritonitis can be minimized when undertaking laparoscopic removal of ovarian dermoid cysts if the peritoneal cavity is washed out thoroughly from spillage of cyst contents. Drainage of peritoneal cavity should be performed in the patients with the ruptured dermoid cysts.

Rupture of a benign cystic ovarian teratoma may result in severe chemical granulomatous peritonitis, a condition mimicking peritonitis carcinomatosa, with patients complaining of common abdominal symptoms. As the precipitating cause of rupture is often indeterminate and the rupture itself is hard to recognize, it is difficult to differentiate from peritonitis of other etiologies, such as gastrointestinal malignancy. We report the case of a 72-year-old female who presented with recurrent pyrexia and abdominal distension. Laboratory data showed signs of inflammation and a high level of carbohydrate antigen 125. Imaging examinations showed left-side-dominant pleural effusion, ascites with peritoneal adhesions, and a left cystic ovarian teratoma. Repeat paracentesis of both the pleural effusion and ascites demonstrated exudative characteristics, but there was no indication of malignancy or signs of infection, including those of tuberculosis. Although exploratory laparotomy was then recommended for conclusive diagnosis and ruling out such gynecological malignancy, the patient declined. Fortunately, laboratory data, radiological images, and other clinical findings gradually improved over the following 12 months. Moreover, a retrospective review of the computed tomography images revealed lipid particles in the ascites, indicative of teratoma rupture. The final diagnosis was chemical peritonitis and pleuritis caused by spontaneous rupture of the benign cystic teratoma. The present case was extremely rare with regard to its diagnosis and clinical progression. Our experience suggests that chemical peritonitis should be included in the differential diagnosis of peritonitis. [ABSTRACT FROM AUTHOR]

During the standard heat sterilization process of the lactate-buffered peritoneal dialysis solutions, glucose (an osmotic active substance) degrades to form compounds called glucose degradation products which are cytotoxic and affect the survival of the peritoneal membrane. This case presentation is based on an observation of 224 aseptic peritonitis cases of unknown etiology. For the purpose of clarification, we analyzed the peritoneal dialysis solutions for the presence of acetaldehyde by using a developed and validated high-performance liquid chromatography (HPLC) pre-column derivitazation. The method was validated with respect to validation factors such as linearity, precision, recovery and (LOD). The acetaldehyde level of solutions before heat sterilization was 1.78 ± 2.7 ppm whereas in samples after heat sterilization was about 20 ± 2.07 ppm. Based on the forementioned findings, we hypothesized that the higher levels of acetaldehyde and possibly the other glucose degradation products may have been an etiological factor in these 224 cases of chemical peritonitis. So it is important for the manufacturers to carefully review the heat of sterilization process in the production line. [ABSTRACT FROM AUTHOR]

Thirty two years multipara with amenorrhoea of five months presented with bleeding per vagina for ten days. Clinically and radiologically she was diagnosed with intrauterine fetal demise at 20 weeks period of gestation. She was induced with prostaglandins continuously for seven days. On eighth day of admission features of uterine rupture was present. On laparotomy ruptured huge dermoid cyst with chemical peritonitis was discovered. There was no evidence of pregnancy. We are reporting this case for a rare complication of ruptured dermoid cyst and also to illustrate the importance of clinical assessment. DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7305 Journal of Nobel Medical College (2012), Vol.1 No.2 p.82-83

Abdominal pain is a frequent presentation to the Emergency Department and it is often difficult to find a clear diagnosis. This is a unique case of a woman with worsening abdominal pain over 2 days with no clear etiology despite extensive, repeat evaluations with eventual spontaneous resolution. The diagnosis of chemical peritonitis was established when the patient revealed an extremely rare mechanism of injury the night before presentation that has never been described previously. Access to the abdominal cavity through the uterus has been documented by retrograde flow during menses, and through vigorous insufflation during oral sex leading to pneumoperitoneum. Passage of an exogenous fluid through the same mechanism mimicking an acute abdomen has never been documented. This entity presents another possible explanation for the frequently encountered abdominal pain that after thorough work-up does not have a definitive diagnosis. [Copyright &y& Elsevier]

Gastric rupture following blunt abdominal trauma is rare, with a reported incidence of 0.02–1.7%. Road traffic accidents remain the most frequent cause. The factors most often implicated in the genesis of this entity are: a history of a recent meal, trauma to the left side of the body and an inappropriate use of seat belts. Splenic injury is generally the most common associated injury. The high morbidity and mortality are directly related to the number of associated injuries, delays in diagnosis and the development of intraabdominal sepsis. We performed a retrospective study of 1300 patients with blunt trauma to the abdomen from 1973 to 2001. Seven patients sustained a gastric rupture (five men and two women). The following associated characteristics were analysed: mechanism of injury, clinical presentation, possible associated injuries and postoperative complications, diagnosis methods and surgical treatment. We found an incidence of gastric rupture of 0.5%. We emphasise an early diagnosis and aggressive surgical treatment as a key to decreasing the mortality and morbidity from this injury. However, in our series, the morbidity is mainly from associated injuries. [Copyright &y& Elsevier]

ABSTRACT Objective To evaluate the results of the surgical management of large dermoid cysts by laparoscopic extracorporeal cystectomy. Design The results of the surgical management by laparoscopic extracorporeal cystectomy of large (≥8 cm) dermoid cysts in 21 women, were evaluated in a retrospectively designed study. Setting Ankara University School of Medicine, Obstetrics and Gynaecology Clinic. Intervention After the cyst had been aspirated and decompressed, it was pulled out through the trocar site, the 10-mm suprapubic trocar incision having been enlarged to 25 mm. The aim of this was better identification of functional ovarian tissue and extracorporeal completion of cystectomy. The remaining ovarian tissue, that appeared to be functional, was pushed back into the peritoneal cavity. The duration of hospitalization, operating time, intraoperative blood loss and postoperative morbidity were evaluated. Results All of the large cysts were managed successfully by laparoscopic extracorporeal cystectomy. The mean age of the patients was 28.5 ± 4.9 years (range 21–37). The mean diameter of the cysts was 11.2 ± 2.7 cm (range 8–17 cm), the mean operation time was 65.8 ± 13.9 min (range 45–95 min), and the mean duration of hospitalization was 1.8 ± 0.7 days (range 1–3 days). Average blood loss was less than 35 ml. Despite considerable efforts to keep leakage of cyst contents to a minimum, this did occur to some extent and was managed successfully by copious lavage in all patients. None of the patients developed postoperative morbidity associated with chemical peritonitis. Conclusion Laparoscopic extracorporeal cystectomy is a safe and effective technique in the management of large dermoid cysts. Functional ovarian tissue could be well identified and preserved by direct visualization. [ABSTRACT FROM AUTHOR]

Background. During the standard heat sterilization process of lactate‐buffered peritoneal dialysis (PD) solutions, glucose degrades to form compounds called glucose degradation products such as acetaldehyde, formaldehyde, or glyoxal. Despite evidence that these products may be responsible for some in vitro cytotoxic effects induced by commercially available PD fluids, data on their acute or chronic effects on the human peritoneum is scarce. [ABSTRACT FROM PUBLISHER]