Page 51 - World Journal of Laparoscopic Surgery

Wandering Dermoid Cyst of Ovary

Fig. 1: CECT showing a mass lesion between the uterus and the rectum Fig. 4: Adhesiolysis with detorsion of the right adnexa with dermoid
maintaining the fat planes with the adjoining tissues cyst in the pouch of Douglas

Fig. 2: CECT showing the calcification and fat tissue in the mass lesion Fig. 5: Wandering dermoid cyst
classically seen in the dermoid cyst
Four-port laparoscopy revealed bulky uterus with torsion of
right ovary and fallopian tube having flimsy adhesions to the pouch
of Douglas (Fig. 3). The left ovary and the fallopian tube appeared
normal with flimsy adhesion to the posterior wall of the uterus.
Careful adhesiolysis with detorsion of right ovary and fallopian
tube was undertaken (Fig. 4). A dermoid cyst measuring 10 x 8 cm
was found to be located in the pouch of Douglas without any
attachment to right ovary (Fig. 5). The dermoid cyst was retrieved
using an endobag, avoiding any spillage of its contents (Fig. 6). The
procedure was uneventful and the patient was discharged within
36 hours of surgery. The histopathologic diagnosis confirmed it
to be a benign mature cystic teratoma with diffuse hemorrhagic
infarction and areas of necrosis with features considered consistent
with torsion.

discussion
3
Lefkowitch et al. reported the first such case in 1978, in which a
Fig. 3: Torsion of the right adnexa woman had presented with urinary retention. Under the impression
of a fibroid uterus, laparotomy was performed and a benign cystic
The procedure of laparoscopic ovarian cystectomy was planned teratoma of the retrouterine pouch of Douglas was found.
and undertaken following an informed consent and a discussion Dermoid cysts arise from germ cells that originate in the mature
regarding possible findings and treatment. gonads. In embryonic life, migration of the germ cells occurs along

50 World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023)