Hong Kong medical journal = Xianggang yi xue za zhi | 2019
Ruptured ovarian teratoma with granulomatous peritonitis.
Abstract
In January 2017, a 35-year-old woman was admitted to our hospital with insidious onset of upper abdominal pain. A computed tomography (CT) scan showed bilateral ovarian cysts with fat fluid level, calcifications, and Rokitansky protuberance, compatible with ovarian teratoma (Fig 1). Antidependent fatty pockets with soft tissue rim were found at the bilateral subphrenic space, likely representing reactive changes to spilt cyst content, which also explained the patient’s upper abdominal pain. The patient had stable vital signs and was therefore treated conservatively. Followup ultrasonography scan showed globular fatty locules on the liver surface, compatible with escaped fatty cyst content (Fig 2). Subsequently, the patient underwent bilateral ovarian cystectomy. Histology confirmed bilateral ovarian mature cystic teratoma. Intra-operatively, widespread flimsy adhesions and multiple sebum-like implants were seen in the peritoneal cavity, consistent with changes related to teratoma rupture. The peritoneal cavity was irrigated and her symptoms gradually subsided; however, follow-up CT showed mild interval enlargement of the fat-attenuated lesions (Fig 3).