Chemical Peritonitis Due to Ruptured Ovarian Teratoma: A Case Report and Literature Review

Abstract

Introduction: Mature cystic teratomas (MCT) are the most common ovarian tumors in pediatric patients, often asymptomatic due to slow growth, when symptomatic, they can lead to abdominal pain. Spontaneous rupture can result in acute chemical peritonitis (CP), a rare but life-threatening complication. This study presents a clinical case of a patient with spontaneous rupture of an ovarian teratoma and associated acute CP. Clinical Case: 13-year-old female presented with acute abdominal pain, fever, distended and painful abdomen with peritoneal reaction in the right iliac fossa and hypogastrium. Abdominal ultrasound showed a hypoechoic rounded image with an anechoic center in the right adnexal region. Laparoscopic exploration revealed a cystic teratoma of the right ovary with torsion, but no compromise of vitality. Purulent fluid indicated CP due to ruptured and twisted ovarian teratoma. Right ovarian cystectomy was performed, drainage was offered in the Douglas pouch. The patient's condition improved, and she was discharged after recovery. Discussion: Rupture and CP are rare but require emergency surgery. Preoperative diagnosis can be challenging due to their non-specific clinical presentation and the need to rule out malignant complications. Conclusion: Early and appropriate management of MCT is essential to prevent serious complications. Sebum spillage can cause CP, the treatment of choice is teratoma removal, combined with extensive lavage to avoid chronic peritonitis. Laparoscopic surgery stands out as a safe and effective option. A high index of suspicion and comprehensive approach are emphasized in managing this uncommon condition in the pediatric population.