O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 23 An unusual case of keratin granuloma peritonealis following spontaneous rupture of mature ovarian cystic teratoma: A case report and discussion K Baloyi, D Muavha, N Chirwa, RV Mabasa and TM Bendlela, A Misra Department of Obstetrics and Gynaecology, Pietersburg Provincial Hospital, University of Limpopo, South Africa Introduction Ovarian tumours are frequently encountered in gynecological practice and most of them are benign in nature. 2,3,6 e prevalence of benign ovarian tumour in premenopausal women is about 7-10%, 15,16 of which 70% are mature cystic teratoma commonly known as dermoid cyst. ey are insidious tumours where symptoms can appear a er many years, 3 10-15% of them can present bilaterally. 1-4 Dermoid cyst is a type of benign germ cell ovarian tumour. e cyst is lined by the epithelium which contains a variable mixture of well di erentiated tissues of one or more of the three cell lines ecto-, meso- and endoderm such as hair, teeth, sebaceous secretions, skin, fat, muscles, bone etc. 5,6 e most common complication of dermoid cyst is the torsion(16%) which is attributed to its weight. 17 Rupture(1.2%), infection(1.3%), focal malignant transformation(1-2%), hemolytic anemia and paraneoplastic encephalitis are infrequent complications. 9 Rupture of an ovarian cystic teratoma may result in severe chemical peritonitis following intraperitoneal spillage of the cyst contents. 4,7,9 Granulomatosis involving the peritoneum is a rare reactive tumor-like lesions in response to leakage of contents such as keratin or sebum. 18 We are reporting a case of keratin granuloma peritonealis following spontaneous rupture of dermoid cyst. Only a few such cases are published in English literature. Case Report A40year old femalepresented to the accident andemergencydepartment with three months history of gradually increasing abdominal distension and pain which got worse for past ten days. e pain was so severe that she was bed bound and could not sleep. ere was no associated vomiting or diarrhoea. ere was no history of cough, night sweats or fever. She had good appetite but could not eat due to pain and had lost weight. She is gravida four, para three, had three vaginal deliveries and one ectopic pregnancy. She was using Depot-Provera for contraception since 2017 and her last normal menstruation was een days before presentation. On examination, she looked acutely ill with normal temperature of 37°C, her pulse rate was 92 beats/minute and blood pressure was 115/73 mm Hg. Her respiratory rate was 22 breaths/minute, oxygen saturation was 97% on room air. Urinalysis showed a trace of leukocytes but otherwise unremarkable. Her cardiovascular and respiratory systems were normal. Her abdomen was grossly distended with guarding and rebound tenderness. On speculum examination, there was no abnormal vaginal discharge or bleeding, the cervix and vagina were normal. e di erential diagnoses included a torsion/rupture of ovarian cyst, Abstract Mature ovarian teratoma is a common benign tumour in women of reproductive age group. This is a slowly growing tumour often remains asymptomatic for a long period of time unless large sized or some complication occurs. Torsion is the most common complication, whereas rupture is an unusual complication of mature teratoma. We report a case of keratin granuloma peritonealis, a very rare condition following spontaneous rupture of mature ovarian teratoma. Rarity of this condition warrants its mention. A 40 year old female presented with an acute abdomen with the background history of gradually increasing abdominal pain and distension for three months. She had exploratory laparotomy which revealed keratin granulomas and chemical peritonitis. The diagnosis of spontaneously ruptured teratoma was made. The abdomen was closed following rigorous peritoneal washout. After an interval of 8 weeks, left adenexectomy and adhesiolysis were performed. She made full recovery after the surgery. Key words: Ovarian dermoid cyst; mature ovarain cyst teratoma; spontaneous rupture; keratin granuloma peritonealis. Correspondence Misra A email: rajeevashamisra@yahoo.com O&G Forum 2021; 31: 23 - 27 CASE REPORT