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\begin{document}

\title{Acute post-traumatic dermoid peritonitis: a rare entity}



\author[1]{sami Fendri}%
\author[2]{Haitham Rejab}%
\author[2]{Ayman Trigui}%
\author[2]{Bassem Abid}%
\author[2]{Youssef Mejdoub}%
\author[2]{Ahmed Bouzid_ahmed}%
\author[2]{kais fourati}%
\author[2]{Salah  Boujelbene}%
\affil[1]{Habib Bourguiba Hospital}%
\affil[2]{University of Sfax Faculty of Medecine of Sfax}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\selectlanguage{english}
\begin{abstract}
Rupture of ovarian dermoid-cyst is rare case. We report the case of a
woman admitted for acute post-traumatic abdominal pain due to ruptured
ovarian cyst. The patient was operated and we found a very abundant
peritoneal effusion with left ovarian cyst which was broken. we
performed a left adnexectomy.%
\end{abstract}%



\sloppy


\textbf{Acute post-traumatic dermoid peritonitis: a rare entity}

Authors~: Sami Fendri\textsuperscript{1,3}, Haitham
Rejab\textsuperscript{1,3}, Ayman Trigui\textsuperscript{1,3}, Bassem
Abid \textsuperscript{2,3}, Youssef Majdoub\textsuperscript{1,3}, Bouzid
Ahmed\textsuperscript{1,3}, Fourati Kais\textsuperscript{1,3}, Salah
Boujelbene\textsuperscript{1,3}

\begin{enumerate}
\tightlist
\item
  General surgery department; Habib Bourguiba hospital, Sfax, Tunisia
\item
  Departement of Anatomy, Sfax medical School
\item
  Sfax medical school, university of Sfax, Tunisia
\end{enumerate}

\emph{Corresponding author:}

Sami Fendri

General surgery department~; Habib Bourguiba hospital, Sfax, Tunisia

Sfax medical school, university of Sfax, Tunisia

Mail~:\emph{sami.fendri@hotmail.com}

Phone number~: +21658121841

\emph{Conflict of Interest~:}

none for all authors

ACKNOWLEDGEMENT

None declared.

AUTHOR CONTRIBUTIONS

S Fendri conceived the idea for the document and contributed to the
writing and editing of the manuscript.

H Rejab contributed to the writing and editing of the manuscript.

A Trigui reviewed and edited the manuscript.

B Abid reviewed and edited the manuscript.

Y Majdoub reviewed and edited the manuscript.

A Bouzid reviewed and edited the manuscript.

K Fourati reviewed and edited the manuscript.

S Boujelbene contributed to the literature review, manuscript writing,
editing, and review of the manuscript. All authors read and approved the
final manuscript.

ETHICAL APPROVAL

Personal data have been respected.

CONSENT:

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.

DATA AVAILABILITY STATEMENT:

Personal data of the patient were respected.

\textbf{Keyword:}

; Ovarian cyst ; dermoid ; Peritonitis ;

\textbf{Introduction :}

Dermoid peritonitis is secondary to intraperitoneal rupture of a dermoid
cyst (or mature teratoma). This is the most common complication after
torsion. The rupture can be in a hollow organ or in the peritoneal
cavity.

\textbf{Observation~:}

A 75-year-old patient, with no particular pathological history, admitted
for acute post-traumatic abdominal pain. Indeed, she was the victim of a
domestic accident: She was fallen from her height.

The clinical examination found the temperature at 38\selectlanguage{ngerman}°C, diffuse
abdominal tenderness and significant abdominal distension.

Biology showed a biological inflammatory syndrome with hyperleukocytosis
at 16,500 elements/mm3 with a CRP at 78 mg/l.

CT scan found a left ovarian cyst with a dermoid appearance
(calcifications with heterogeneous contents) associated with abundant
intraperitoneal effusion with diffuse infiltration of intra-abdominal
fat. A ruptured ovarian cyst in the peritoneum was concluded.

The patient was operated urgently. We found a very abundant peritoneal
effusion made of sero-hematic fluid, sebum, tufts of hair and some hard
calcium debris (Figure 1). There was also a left ovarian cyst which was
broken (Figure 2). Regarding her age, we performed a left adnexectomy
removing the ruptured dermoid cyst with abundant peritoneal cleaning
(Figure 3).

The postoperative course was simple after 2 days in intensive care unit.

\textbf{Discussion~:}

The dermoid cyst is a very common ovarian tumor (approximately 25\% of
ovarian tumors) {[}1{]}. It occurs mainly in women during period of
genital activity {[}2{]}.

In half of the cases, it is asymptomatic {[}2-5{]}. It can be discovered
as a result of pelvic pain, menstrual irregularities or complications
{[}2,5{]}.

Diagnosis is based on imaging data, particularly ultrasound and CT,
which highlight the presence of heterogeneous calcium and fatty
components {[}6{]}. The complications of these ovarian cysts are
dominated by torsion (15\%), rupture (1.3\%), infection (1 to 2\%) and
more rarely haemorrhage {[}2{]}.

Rupture in the peritoneum is complicated by chemical peritonitis
{[}2,8,9{]}. The treatment of ruptured dermoid cysts of the ovary is
surgical, either by laparotomy or by laparoscopy.

Cystectomy is the standard procedure in young women, while oophorectomy
or adnexectomy is most often performed in postmenopausal women
{[}7,10{]}.

Abundant washing of the peritoneal cavity should be performed with
saline solution and all visible particles of dermoid material (hair,
bone, fat and sebum) should be removed {[}10{]}.

Examination of the anatomo-pathological specimen is essential and
mandatory in order to confirm the diagnosis and to look for an immature
dermoid component, in which case further surgery or chemotherapy should
be discussed.

\textbf{Conclusion~:}

Dermoid peritonitis is a rare condition secondary to sudden rupture
(acute form) or cracking (torpid form) of an ovarian teratoma. This
diagnosis should be considered in the presence of peritonitis of non
explained etiology, especially when the CT scan reveals a mature
teratoma. It is important to evoke the acute form in a woman of
childbearing age, presenting a picture of severe pelviperitonitis.

\textbf{Références:}

{[}1{]} Peterson WF, Prevost EC, Edmunds FT, Mason Hundley J, Morris FK.
Benign cystic teratomas of the ovary. A clinicostatistical study of 1007
cases with review of the literature. Am J Obstet Gynecol
1995;70:368--82.

{[}2{]} Huc M, Lafay-Pillet MC, Lecuru F, Ruscillo MM, Chevalier JM,
Vildé F, et al. Peritonite granulomateuse après traitement
coeliochirurgical d'un kyste dermoïde de l'ovaire : diagnostic, prise en
charge, prévention à propos d'un cas. J Gynecol Obstet Biol Reprod
(Paris) 1996;25:365--72.

{[}3{]} Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature
cystic teratoma: a clinicopathologic evaluation of 517 cases and review
of the literature. Obstet Gynecol 1994;84:22--8.

{[}4{]} Rubod C, Triboulet JP, Vinatier D. Kyste dermoïde de l'ovaire
compliqué d'une péritonite chimique. À propos d'un cas. Gynécologie
Obstétrique Fertil. 2007 Jul;35(7--8):651--3.

{[}5{]} Morgante G, Ditto A, La Marca A, Trotta V, De Leo V. Surgical
treatment of ovarian dermoid cysts. Eur J Obstet Gynecol Reprod Biol
1998; 81:47--50.

{[}6{]} Hertzberg B, Kliewer M. Sonography of benign cystic teratoma of
the ovary: pitfalls in diagnosis. Am J Roentgenol 1996;167:1127--33.

{[}7{]} El Moussaoui M, Closon F, Brichant G, Kotzampassakis N, Nisolle
M. Chemical peritonitis complicating the spontaneous rupture of a
dermoid cyst of the ovary. Rev Med Liege 2018; 73 : 7-8 : 408-12.

{[}8{]} Achtari C, Genolet PM, Bouzourene H, De Grandi P. Chemical
peritonitis after iatrogenic rupture of a dermoid cyst of the ovary
treated by coelioscopy. A propos of a case and review of the literature.
Gynakol Geburtshilfliche Rundsch 1998;38:146--50.

{[}9{]} Fiedler EP, Guzick DS, Guido R, Kanbour-Shakir A, Krasnow JS.
Adhesion formation from release of dermoid contents in the peritoneal
cavity and effect of copious lavage: a prospective, randomized, blinded,
controlled study in a rabbit model. Fertil Steril 1996;65:852--9.

{[}10{]} Milad MP, Olson E. Factors that increase the risk of leakage
during surgical removal of benign cystic teratomas. Hum Reprod
1999;14:2264--7.

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