Tejima Kazuaki, Enomoto Runa, Arano Toru, Miwa Jun, Matsubara Yasuo, Tashiro Jun, Tagami Daisuke, Kakimoto Hikaru, Takahashi Masahito, Higa Shirika, Suzuki Akira, Arai Masahiro
Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, Tokyo, 140-8522, Japan.
Department of Gastroenterology, Tokyo Medical and Dental University, University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Clin J Gastroenterol. 2013 Aug;6(4):274-80. doi: 10.1007/s12328-013-0391-0. Epub 2013 Jun 6.
Rupture of a benign cystic ovarian teratoma may result in severe chemical granulomatous peritonitis, a condition mimicking peritonitis carcinomatosa, with patients complaining of common abdominal symptoms. As the precipitating cause of rupture is often indeterminate and the rupture itself is hard to recognize, it is difficult to differentiate from peritonitis of other etiologies, such as gastrointestinal malignancy. We report the case of a 72-year-old female who presented with recurrent pyrexia and abdominal distension. Laboratory data showed signs of inflammation and a high level of carbohydrate antigen 125. Imaging examinations showed left-side-dominant pleural effusion, ascites with peritoneal adhesions, and a left cystic ovarian teratoma. Repeat paracentesis of both the pleural effusion and ascites demonstrated exudative characteristics, but there was no indication of malignancy or signs of infection, including those of tuberculosis. Although exploratory laparotomy was then recommended for conclusive diagnosis and ruling out such gynecological malignancy, the patient declined. Fortunately, laboratory data, radiological images, and other clinical findings gradually improved over the following 12 months. Moreover, a retrospective review of the computed tomography images revealed lipid particles in the ascites, indicative of teratoma rupture. The final diagnosis was chemical peritonitis and pleuritis caused by spontaneous rupture of the benign cystic teratoma. The present case was extremely rare with regard to its diagnosis and clinical progression. Our experience suggests that chemical peritonitis should be included in the differential diagnosis of peritonitis.
良性囊性卵巢畸胎瘤破裂可能导致严重的化学性肉芽肿性腹膜炎，这种情况类似于癌性腹膜炎，患者会出现常见的腹部症状。由于破裂的诱发原因往往不明确，且破裂本身难以识别，因此很难与其他病因引起的腹膜炎，如胃肠道恶性肿瘤相鉴别。我们报告一例72岁女性患者，表现为反复发热和腹胀。实验室检查显示有炎症迹象且糖类抗原125水平升高。影像学检查显示左侧为主的胸腔积液、伴有腹膜粘连的腹水以及左侧囊性卵巢畸胎瘤。对胸腔积液和腹水反复进行穿刺检查显示为渗出性特征，但未发现恶性迹象或感染迹象，包括结核感染迹象。尽管当时建议进行剖腹探查以明确诊断并排除此类妇科恶性肿瘤，但患者拒绝了。幸运的是，在接下来的12个月里，实验室检查数据、影像学图像及其他临床发现逐渐改善。此外，对计算机断层扫描图像进行回顾性分析发现腹水中有脂质颗粒，提示畸胎瘤破裂。最终诊断为良性囊性畸胎瘤自发破裂导致的化学性腹膜炎和胸膜炎。该病例在诊断和临床进展方面极为罕见。我们的经验表明，化学性腹膜炎应纳入腹膜炎的鉴别诊断中。
