title: Disseminated carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma.
abstract: The authors reported the intraperitoneal carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma in a 28-year-old woman. A 28-year-old female patient exhibited intraperitoneal carcinomatosis after a laparoscopic surgery for ruptured mature teratoma of the ovary with occult malignant transformation. The complication was found two months after initial laparoscopic surgery. Laparoscopic surgery was smooth including oophorectomy, and removing all spilled specimens within the abdominal cavity. At the end of the laparoscopic surgery, cleaning the abdominal cavity and irritating the port site were also performed. Cytology of the abdominal cavity and all removed specimens did not show evidence of malignancy. She followed up regularly and uneventfully except for persistently abdominal fullness and erythematous change of umbilical portal site. Evidence demonstrated intestinal obstruction associated with ascites after a detailed evaluation. Although the patient received supportive treatment the symptom exacerbated. Therefore, the patient was treated with exploratory laparotomy. Pathology proved with intraperitoneal carcinomatosis caused by squamous cell carcinoma. All tumor evaluations including tumor markers, a thorough physical examination, imaging studies and evaluations of the nuclear medicine were negative except of intraperitoneal carcinoma, origin to be determined. The patient is dead 14 months' post-treatment by exploratory laparotomy. Although it was not clear that the laparoscopic approach or the disease itself worsened indeed the prognosis because the disease was already disseminated before the laparoscopy, we still emphasized the possible limitation of laparoscopic surgery if diagnosis at original surgery is impaired, of if excision is incomplete and the delay between the laparoscopic procedure and the carcinomatosis.
authors.affiliation: Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei and National Yang-Ming University, Taiwan. phwang@vghtpe.gov.tw
authors.forename: P H
authors.initials: PH
authors.lastname: Wang
authors.forename: W L
authors.initials: WL
authors.lastname: Lee
authors.forename: H T
authors.initials: HT
authors.lastname: Chao
authors.forename: C C
authors.initials: CC
authors.lastname: Yuan
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009366:Neoplasm Seeding; D010051:Ovarian Neoplasms / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000209:etiology*; D012422:Rupture, Spontaneous; D013724:Teratoma / Q000601:surgery*