Page 45 - World Journal of Laparoscopic Surgery

CASE REPORT
Multiple and Bilobed Ovarian Dermoid Cysts: Complications

and their Successful Laparoscopic Management

1
2
Nayanika Gaur , Nitin Shah , Manish Jha 3
AbstrAct
Background: Ovarian dermoid is one of the commonly occurring ovarian neoplasms in young women but the occurrence of multiple dermoid
cysts is comparatively rare.
Case description: This is a case of 24-year-old woman who ignored her first diagnosis and management plan for a 3 × 3 cm dermoid cyst in
one of the ovaries and later returned with severe symptoms of abdominal pain and vomiting and with a CT scan diagnosis of bilateral, large
(7 × 7 cm) dermoid cysts. She was prepared for laparoscopic bilateral dermoid cyst excision, until the intraoperative scenario, revealing right-
sided twisted bilobed dermoid cyst and left-sided twin dermoid cysts changed the original plan. Finally, the patient underwent right-sided
ovariotomy with right-sided salpingectomy and left-sided twin dermoid cysts excision.
Conclusion: Laparoscopy is the surgical mode of choice in dermoid presentations. Evaluation of contralateral ovary must be carried out while
dealing with dermoid cyst of one ovary.
Clinical significance: Torsion of a large dermoid cyst is not an indication for ovariotomy. However, ischemic dermoid cysts require an on-table
judgement for cystectomy or ovariotomy. Laparoscopic management in skilled hands favors cystectomy. Examining contralateral ovary must
be a routine while operating on a patient with dermoid cysts in ovary.
Keywords: Diagnostic laparoscopy, Gynecology, Gynec-oncology.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1390

IntroductIon 1 Department of Obstetrics and Gynecology, All India Institute of
Adnexal masses are commonly encountered and managed by Medical Sciences, Jodhpur, Rajasthan, India
gynecologists. Benign ovarian teratomas or dermoid cysts of the 2 Department of Obstetrics and Gynecology, Vardann Multispeciality
ovary are considered the most common benign ovarian neoplasms Hospital, Mumbai, Maharashtra, India
in young and middle-aged women and account for 20–25% of 3 Department of Anesthesia and Critical Care, All India Institute of
all ovarian tumors in this age group. Usually dermoid cysts are Medical Sciences, Jodhpur, Rajasthan, India
unilateral, but in 10–15% cases, bilateral and/or multiple dermoid Corresponding Author: Nayanika Gaur, Department of Obstetrics and
cysts may be encountered. 1 Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan,
The majority of dermoid cysts are asymptomatic and are often India, Phone: +91 8308609507, e-mail: nayanika.gaur@gmail.com
discovered incidentally. The symptomatic ones are usually with the How to cite this article: Gaur N, Shah N, Jha M. Multiple and
complications of preexisting dermoid cysts like torsion, rupture, or Bilobed Ovarian Dermoid Cysts: Complications and their Successful
rarely malignancy. Laparoscopic Management. World J Lap Surg 2020;13(1):43–45.
With the advances in endoscopic surgery, laparoscopic excision Source of support: Nil

of dermoid cysts has become a gold standard approach. Conflict of interest: None
This case report highlights the occurrence of multiple and
bilobed dermoid cysts, associated complications, the surgical
dilemma of oophorectomy or cystectomy, and successful Examination
laparoscopic management. Her general condition was fair, and vitals were stable. Per abdomen,
a well-defined mass reaching up to umbilicus was felt, and
cAse descrIptIon tenderness on transverse mobility was noted. No ascites was felt.
Case History Investigations
A 24-year-old, Para 1, admitted with complaints of severe abdominal Routine and preoperative investigations were within normal limits.
pain mainly in right iliac fossa radiating to thighs, associated with Ca-125: 36.3 U/mL, CEA: 2.30 ng/mL
complaints of 10–14 episodes of vomiting for one day. No history
of fever, bowel/bladder disturbances, weight loss, or menstrual Ultrasonography
irregularities. No positive family history. Previously, she was diagnosed Right and left adnexal cysts of 7 × 7 cm and 6 × 9 cm with mixed
with a 3 × 3 cm right-sided ovarian dermoid cyst 4 months ago and echogenicity, with fat and fluid contents and focal hyperechoic
was advised surgery, which she refused and was lost to follow-up. lesions were noted. Doppler suggested reduced blood flow in the

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