A 22-year-old woman presents with acute abdomen and a 10 cm right-sided cystic ovarian mass. At surgery, the mass is a mature cystic teratoma (dermoid cyst) with ovarian torsion. Spillage of sebaceous material into the peritoneal cavity occurred during decompression. Which specific complication may result from this spillage?
- A Acute bacterial peritonitis from skin bacteria in the cyst
- B Chemical peritonitis (granulomatous peritonitis) from lipid-rich sebaceous content ✓
- C Pseudomyxoma peritonei from mucinous gland elements
- D Disseminated peritoneal leiomyomatosis from smooth muscle elements
Explanation
Spillage of dermoid cyst contents (sebaceous material, hair, keratin) into the peritoneal cavity triggers a chemical peritonitis characterized histologically by lipid-laden macrophages and foreign body giant cell granulomata—this is granulomatous peritonitis, a well-recognized complication of dermoid cyst rupture or spillage. The lipid-rich sebaceous material incites a chronic inflammatory reaction. Clinical features include peritoneal adhesions, chronic abdominal pain, and fever developing weeks after surgery. This is why meticulous decompression technique with minimal spillage is emphasized during dermoid cyst surgery. Pseudomyxoma peritonei arises specifically from mucinous tumors (appendix, mucinous ovarian tumors), not dermoids.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.