EpistemisComplicated ovarian dermoid cyst
Specialty: Gynecology and breast.
Why it occurs
- Complete or partial torsion of the ovary containing the mature cystic teratoma (due to its high specific weight and asymmetry due to the presence of sebaceous tissue, hair, teeth or bone)
- Spontaneous or traumatic rupture of the cyst with discharge of the fatty and sebaceous contents into the peritoneal cavity, triggering severe chemical peritonitis
- Secondary infection of the dermoid cyst
Initial workup
Urgent transvaginal or abdominal ultrasound (an adnexal mass with a typical "snowstorm" pattern is observed, areas of high echogenicity with acoustic shadowing corresponding to fat, calcifications compatible with teeth or bone, and absence of ovarian Doppler flow if it is torted). Complete blood count with formula, CRP and serum electrolytes. CT or MRI of the pelvis if there are prior diagnostic doubts.
red flags
Sudden, acute and intolerable unilateral abdominal or pelvic pain of maximum intensity immediately, accompanied by nausea, repeated vomiting, signs of peritoneal irritation (abdominal muscle defense, pain on rebound/positive blumberg), high fever, tachycardia, hypotension, or syncope.
Standard management
- There are no drugs indicated to treat the torsion or rupture of a dermoid cyst. Venous cannulation, urgent administration of powerful analgesics such as morphic chloride 2-5 mg intravenously or ketorolac 30 mg intravenously in a controlled manner and perioperative antibiotic prophylaxis are required. The treatment of choice is urgent surgery using laparoscopy to perform ovarian detorsion (assessing the viability of the organ) or cystectomy/adnexectomy (note: intraoperative rupture of the dermoid cyst should be strictly avoided to prevent chronic chemical granulomatous peritonitis).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 3
- Treatment options
- 1