Obstet Gynecol Sci.  2020 Jul;63(4):543-547. 10.5468/ogs.19189.

Granulomatous peritonitis caused by iatrogenic spillage of ovarian dermoid cystectomy: a case report and literature review

• Kim HE
• Seo M
• Kwack JY
• Kwon YS

• KMID: 2505047
• DOI: http://doi.org/10.5468/ogs.19189

Abstract

A 39-year-old nulliparous woman experienced continuous mild fever and abdominal pain since undergoing laparoscopic ovarian dermoid cystectomy 3 months previously in a local hospital. Abdominal computed tomography revealed diffuse heterogeneous fat infiltrations with numerous micronodules in the greater and lesser omentum, combined with ascites with thickening of the parietal peritoneum. The patient underwent exploratory laparoscopy, which included partial pelvic peritonectomy, excision of granulomas, and adhesiolysis with massive irrigation. The patient was treated successfully with laparoscopic surgery and all reproductive structures were spared without operative complications. To avoid peritonitis, complete removal of cyst contents and massive irrigation should be performed during ovarian dermoid cystectomy. Conservative surgical treatment may be a good choice for treating granulomatous peritonitis induced by iatrogenic rupture.

Keyword

Iatrogenic disease; Teratoma, ovarian; Peritonitis

Figure

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  Fig. 1. Preoperative abdominopelvic computed tomography (CT) findings and intraoperative findings of granulomatous peritonitis. (A) Preoperative CT revealing diffuse moderate heterogeneous, smudged fat infiltrations with numerous micronodules in the greater and lesser omentum, combined with diffuse mild ascites with diffuse thickening of the parietal peritoneum, with tubular enhancing granulation tissue in the right lower quadrant abdominal wall. (B) Laparoscopic view revealing profuse sebaceous material in the entire pelvic cavity. (C) Laparoscopic view revealing multiple nodular lesions in the greater and lesser omentum.

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  Fig. 2. Histological findings of peritoneal nodules. (A) Chronic inflammation and fibrosis of the omentum (hematoxylin and eosin [H&E] staining, original magnification ×40). (B) Hair follicle-like structure in the omentum (H&E staining, original magnification ×200). (C) Damaged hair follicle-like structure with multinucleated giant cells (H&E staining, original magnification ×200). (D) Foreign-body type granuloma (H&E staining, original magnification ×200).

Reference

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