Maiti Sachchidananda, Fatima Zamurrad, Anjum Z K, Hopkins R E
Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK.
J Med Case Rep. 2008 Jun 12;2:203. doi: 10.1186/1752-1947-2-203.
This case illustrates the unusual complication of granulomatous peritonitis following rupture of a dermoid cyst in pregnancy resembling disseminated ovarian carcinoma. To the best of the authors' knowledge, this is the first report of this complication during advanced pregnancy in the literature.
A dermoid cyst ruptured during surgical removal in the second trimester of pregnancy in a 27-year-old primigravida. Postoperatively the patient suffered pulmonary embolism and leakage of sebaceous material through the abdominal wound. She gradually developed significant abdominal distension, gastrointestinal symptoms and lost more than 8 kg of weight in the 12 weeks postoperatively. The baby was delivered at 31 weeks by a technically challenging caesarean section owing to severe dense adhesions obscuring the uterus. Bowel resection was performed for suspected malignant infiltration and adhesion causing obstruction. She had a protracted convalescence with an ileostomy and mucus fistula. Histology confirmed granulation without malignancy. One year following the surgical treatment, she had recovered well and was planning her next pregnancy.
Although granulomatous peritonitis following rupture of a dermoid cyst is very rare, awareness is the key to diagnosis and appropriate management. Per-operative frozen section may be helpful.
本病例说明了妊娠期间皮样囊肿破裂后发生肉芽肿性腹膜炎这一罕见并发症，类似播散性卵巢癌。据作者所知，这是文献中首次报道晚期妊娠期间出现这种并发症。
一名27岁初产妇在妊娠中期手术切除皮样囊肿时囊肿破裂。术后患者发生肺栓塞，皮脂腺物质经腹部伤口渗漏。术后12周内，她逐渐出现明显腹胀、胃肠道症状，体重减轻超过8公斤。由于严重致密粘连使子宫难以辨认，在31周时通过技术难度较大的剖宫产分娩婴儿。因怀疑恶性浸润和粘连导致梗阻，进行了肠切除术。她经历了漫长的康复期，带有回肠造口术和黏液瘘。组织学检查证实为肉芽组织，无恶性病变。手术治疗一年后，她恢复良好，并计划再次怀孕。
尽管皮样囊肿破裂后发生肉芽肿性腹膜炎非常罕见，但提高认识是诊断和恰当处理的关键。术中冰冻切片可能会有所帮助。
