Disseminated carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma

The authors reported the intraperitoneal carcinomatosis after laparoscopic surgery for presumably benign ruptured ovarian teratoma in a 28-year-old wo man. 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 aft er initial laparoscopic surgery. Laparoscopic surgery was smooth including oophorectomy, and removing all spilled specimens within the abdominal cavit y. At: the end of the laparoscopic surgery, cleaning the abdominal cavity a nd irritating the port site were also performed. Cytology of the abdominal cavity and all removed specimens did not show evidence of malignancy. She f ollowed up regularly and uneventfully except for persistently abdominal ful lness and erythematous change of umbilical portal site. Evidence demonstrat ed intestinal obstruction associated with ascites after a detailed evaluati on. Although the patient received supportive treatment the symptom exacerba ted. Therefore, the patient was treated with exploratory laparotomy. Pathol ogy proved with intraperitoneal carcinomatosis caused by squamous cell carc inoma. All tumor evaluations including tumor markers, a thorough physical e xamination, imaging studies and evaluations of the nuclear medicine were ne gative except of intraperitoneal carcinoma, origin to be determined. The pa tient is dead 14 months' post-treatment by exploratory laparotomy. Although it was not clear that the laparoscopic approach or the disease itself wors ened indeed the prognosis because the disease was already disseminated befo re the laparoscopy, we still emphasized the possible limitation of laparosc opic surgery if diagnosis at original surgery is impaired, of if excision i s incomplete and the delay between the laparoscopic procedure and the carci nomatosis. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.