Delivery Induced Intraperitoneal Rupture of a Cystic Ovarian Teratoma and Associated Chronic Chemical Peritonitis

Intraperitoneal rupture of cystic ovarian teratoma is a rare complication. We report a case in a 29-year-old female, with increased abdominal circumference 2 months after vaginal delivery. MRI/CT raised this diagnosis associated to chemical peritonitis. A malignant ovarian mass with peritoneal carcinomatosis was excluded. Laparoscopic oophorectomy was performed and histologic analysis confirmed imaging findings. This case demonstrates the interest of imaging before surgery in pelvic masses to avoid misdiagnosing and to provide adequate treatment. 1. Introduction Mature cystic teratoma of the ovary is the most common ovarian neoplasm, accounting for between 5 and 25% of all ovarian tumors. It occurs most commonly in young females and is bilateral in 8–15% of cases. It comprises a cyst lined by an epidermis-like epithelium and contains a variable admixture of elements of one or more of the three cell lines, meso-, endo-, and ectodermal derivatives including sebaceous secretions, hair, teeth, bone, or fat, and is asymptomatic in most of cases; however, it may represent serious complications including torsion (16%), followed by spontaneous rupture (1.3%) and infection (1.2%) and rarely malignant degeneration and hemolytic anemia. 2. Case Report A 29-year-old female patient, gravid 2, para 2, was addressed to our radiological department by her gynecologist for investigation of a left ovarian mass and increased abdominal circumference 2 months after normal vaginal delivery. MRI was obtained and showed a large heterogenous left ovarian mass measuring 85 × 50 × 45？mm with fatty, solid, and liquid contents and a small calcification of 10？mm suggestive of cystic teratoma (Figure 1). Ascites and peritoneal thickening were also detected with fat globules in the cul de sac. Figure 1: Axial T1 weighted (a) and with fat saturation (b). Images show a large heterogenous left ovarian mass measuring with fatty, solid, and liquid contents and a small calcification on coronal T2 weighted image (c) suggestive of cystic teratoma. Axial T1 postcontrast image (d) demonstrates ascites with peritoneal thickening. A CT scan was also obtained to confirm the diagnosis of delivery induced intraperitoneal rupture of a cystic ovarian teratoma and associated chronic chemical peritonitis (Figure 2). Figure 2: Sagittal T2 weighted image (a) and axial CT (b) demonstrate intraperitoneal rupture with fat globules in the cul de sac (arrow) and below the right hemidiaphragm (arrowhead), a pathognomonic finding. The patient underwent laparoscopic oophorectomy. Lyses of the dense adhesions and