Introduction: Dermoid cysts or mature cystic teratomas of the ovary are the most common form of germ cell tumours accounting for 20-25% of all ovarian masses. Laparoscopic surgery is widely accepted as gold standard treatment for benign ovarian masses, including dermoid cysts. Spillage of cyst contents during laparoscopic ovarian cystectomy is significantly higher when compared to an open approach. Chemical peritonitis is a rare complication due to the spillage of dermoid cyst contents in to the abdomen with a reported incidence of 0.2%.
Case: A 24 year old underwent an elective laparoscopic dermoid cystectomy for management of a symptomatic 10cm right ovarian dermoid cyst. There was rupture of the cyst at the time of surgery and >4Litres of normal saline was used to irrigate the abdominal and pelvic cavity. She presented 9 days following her surgery with severe abdominal pain and the clinical assessment was consistent with severe post operative sepsis and peritonitis. A CT scan was suggestive of a probable pelvic collection and she underwent an emergency laparoscopy and washout of the abdomen and pelvis following initial management of sepsis. The peritonitis was initially presumed to be bacterial in nature, however overtime the diagnosis was more in fitting with a chemical peritonitis. She had an initial 42 day hospital re-admission followed by multiple representations with abdominal pain and recurrent need for drainage of intra-abdominal collections with repeated surgery as well as drainage under radiological guidance. The requirement for repeated drainage is on-going to date, now 9 months following the initial laparoscopic management of the dermoid cyst.
Conclusion: Spillage of cyst contents during laparoscopic ovarian cystectomy cannot always be avoided. Laparotomy may be considered as the preferred approach for larger dermoid cysts to avoid the risk of chemical peritonitis.