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Background: Mature cystic teratoma (MCT) comprises 95% of ovarian germ cell tumors with 10-25% incidence in adults.The sequelae include torsion (15%), malignant transformation (1-2%), infection (1%), and rupture (0.3-2%).Spontaneous ruptures of MCT with spillage of sebaceous material into the abdominal cavity are rare due to its thick capsules.Ruptured ovarian teratoma can lead to chemical peritonitis, which is uncommon with diverse presentations.It presents with contralateral abdominal pain due to spillage of its contents into the opposite side of the abdominal cavity following tumor rupture.Case description: This is an unusual presentation of twisted and ruptured ovarian teratoma.A 26-year-old para 1 presented with persistent left lower abdominal pain that radiated to right and sought treatment from various clinics for a week duration.She was referred to a tertiary hospital for ruling out acute appendicitis for right-sided lower abdominal pain where the appendix is located.At first, she presented with sudden onset of moderate-to-severe left iliac fossa (LIF) pain during a bowel opening 5 days ago.Subsequently, the pain radiated to the right iliac fossa (RIF) and worsened on the day of admission.She also had multiple episodes of vomiting and vague suprapubic mass for 1 week.Abdominal examination revealed a palpable cystic suprapubic mass which is about 10 × 8 cm with persistent RIF pain.Ultrasonography showed a solid cystic mass at the LIF measured about 11 × 6 cm and the right ovary was visualized, with normal size uterus and thin endometrial lining.There was significant amount of free fluid, with normal kidneys seen.Ultrasound examination provided an inconclusive diagnosis and an emergency laparotomy was performed for suspicion of a ruptured ovarian cyst with a differential diagnosis of a perforated appendix.There was a twisted and ruptured left ovarian teratoma with a gangrenous base found intraoperatively which contains sebum, hair, and slough at the anterior part of the uterus and thicken omentum.Left-sided salpingo-oophorectomy and omentectomy were done.The peritoneal cavity was washed with copious amounts of warm saline. Conclusion:A ruptured dermoid cyst is one of the gynecological emergencies but is often an overlooked diagnosis.Mature ovarian teratoma consists of well-differentiated germ cell layers derivatives developing as hair, muscle, teeth, or bone.The size of dermoid cysts and torsion with infarction can contribute to their rupture.Correct diagnosis and timely surgical intervention are essential for preventing chemical peritonitis, long-term sequelae, and conserving the reproductive function.
Neoh et al. (Wed,) studied this question.