O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 25 Figure 6 Sagittal T2W and T2 fat suppression sequence: Amass in the le adnexa with a solid component. e cystic component is noted attached to the anterior peritoneal lining. Multiple pockets of uid within the pelvis. Postoperatively, patient reported on and o mild abdominal pain. She was empirically given a short course of steroids; predenisolone 5 mg x daily for 7 days to mitigate the e ect of chemical peritonitis. A relook laparotomy and le adenexectomy were performed a er 8 weeks of primary surgery to avoid the risk of recurrent leakage and chemical peritonitis. Intraoperative ndings at relook laparotomy included 200 mililitres of peritoneal uid along with some globules, the cyst wall had ruptured and had two nodules within it. e cyst arose from le ovary and was attached to the anterior abdominal wall, le fallopian tube, posterior surface of uterus, anterior surface of rectum and the omentum. e right ovary was normal, however the right fallopian tube looked in amed and both ovary and tube were covered with adhesions. e uterus was normal. Bowel and omentum were normal. e cyst wall was dissected away from adjacent structures and le adenexectomy was performed. Histology demonstrated benign mature cystic teratoma with focal areas of squamous epithelium, pseudostrati ed respiratory epithelium with mucinous salivary gland, mature cartilage, glial tissue and adipose tissue. e adjacent tube was normal. Figure 7 Relaparotomy after eight weeks: The cyst wall is ruptured and adherent to adjacent structures. Two solid nodules (Rokitansky nodules) are seen within the cyst. Figure 8 Re-laparotomy a er eight weeks: Normal uterus, cyst wall has been dissected away from the adjacent structures. Figure 9 e resected ovarian cyst. Discussion e word “teratoma” is derived from the Greek word “Terato” meaning monster probably related to the presence of tissues such as teeth, hair and bones. is term was rst used by Virchow in 1863. 5,6,11 In most cases dermoid cysts are asymptomatic, only 3-4% of women present with acute abdominal pain which is usually because of torsion. 2,8 Other causes of pain can be rupture or infection of the cyst. Nonetheless, rupture of dermoid cyst is uncommon due to its thick wall. 6 e cyst may rupture into the peritoneal cavity or infrequently into the adjacent hollow organs such as bowel, bladder, or vagina. 6,11 e exact cause of rupture is unknown in most cases; however, factors such as prolonged pressure during pregnancy and labour, torsion with infarction, direct trauma, malignant transformation, O&G Forum 2021; 31: 23 - 27 CASE REPORT