Page 52 - World Journal of Laparoscopic Surgery

Wandering Dermoid Cyst of Ovary
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any ligamentous connection with the pelvic organs. Another
patient had an impending uterine rupture with a large dermoid
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cyst impacted in the pouch of Douglas separate from the adnexa.
The third patient presented with obstructed labor and intra-
uterine fetal demise. Exploration revealed a dermoid cyst adherent
to the urinary bladder. 5
One case of parasitic dermoid has been reported whose
etiology has been attributed to previous dermoid cystectomy
where there was spillage of contents in the abdomen. 9
Intraoperatively, dermoid cyst spill may result in chemical
1
peritonitis or a recurrence of similar lesion in future. Utmost care
should be taken to prevent this or else generous suction irrigation
will help to avoid future complications.
In our case, the whole cystic mass was retrieved in an endobag
without any spillage of contents onto the surrounding structures.
Three-year follow-up of the patient has not shown any recurrence
of the lesion.
Fig. 6: Dermoid cyst retrieved enmasse in endobag
Clinical Significance
the route of the mesentery toward the primitive gonads. These cells However, uncommon the parasitic dermoids are, the surgeon
in future life might give rise to spectrum of tissues originating from
the three primitive embryonic layers, including the dermoid cysts. 2 should always have this as a differential diagnosis while dealing
Torsion of the pedicle, rarely, may lead to autoamputation and with large dermoid cysts. Laparoscopy is the preferred modality to
reimplantation of the ovarian dermoid or even the ovary forming deal with this condition but the technique and skills are required to
the parasitic tumor. 2 retrieve it en masse to prevent the complications of spillage. Few
In this index case, CT scan and pelvic sonography revealed the case reports have reported the auto amputation of the ovary along
cyst being in close contact with the right ovary without obvious with these teratomas, hence a timely action may help to save the
evidence of torsion. However, laparoscopy findings included no ovarian function of these women.
demonstrable attachment of the tumor to the right ovary as the
adnexal torsion was unwound. The lesion was seen lying free in references
the pouch of Douglas showing a hemorrhagic pedicle suggesting 1. Bartlett CE, Khan A, Pisal N. Parasitic dermoid cyst managed
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confirmed on laparoscopy and histopathology. Rep 2009;3:63. DOI: 10.1186/1752-1947-3-63.
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DOI: 10.1016/j.jmig.2008.07.014.
by the pouch of Douglas (12 reported cases) signifying the rarity 3. Lefkowitch JH, Fenoglio CM, Richart RM. Benign cystic teratoma of
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lump in right flank since 3 months. X-ray of abdomen and contrast- CA19-9 levels: A case report. Case Rep Womens Health 2019;24:e00156.
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At laparotomy, huge nodular, highly vascular mass that was 2010;15(3):216–218. DOI: 10.1016/j.mefs.2010.06.004.
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flimsy adhesions to the peritoneum of the pouch of Douglas. section. Fertil Steril 2009;91(4):1294,e9–e12. DOI: 10.1016/j.
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World Journal of Laparoscopic Surgery, Volume 16 Issue 1 (January–April 2023) 51