卵巣成熟嚢胞性奇形腫に対する腹腔鏡下卵巣嚢腫摘出術後、化学性腹膜炎を生じその治療に苦慮した1例

抄録

  We encountered a case of chemical peritonitis caused by iatrogenic complication after laparoscopic cystectomy in a patient with ovarian mature cystic teratoma (MCT).

  A 40-year-old woman, gravida 0, underwent laparoscopic cystectomy for MCT. During surgery, contents from the MCT leaked and diffused into the abdominal cavity. After the operation, she complained of fever and lower abdominal pain. Computed tomography demonstrated several findings of peritonitis, such as a thickened peritoneum and ascites. She was diagnosed with peritonitis and treated initially with antibiotics; however, this was not effective. Since we suspected chemical peritonitis, we proposed reoperation. Although she rejected our proposal, oral adrenocortical steroids were administered. Fortunately, her condition promptly improved.

  Currently, laparoscopic cystectomy for young patients with MCT has become very common. The leakage of contents from MCTs is sometimes inevitable, and once chemical peritonitis occurs, its treatment is often very difficult. We think the most important prophylaxis for chemical peritonitis is minimizing the leakage of MCT contents, and if leakage diffuses into the abdominal cavity, thorough lavage should be required during operation.