骨盤腹膜炎を契機に診断された遊離卵巣嚢腫の一例

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Introduction: Ovarian auto-amputation is extremely rare and is most commonly attributed to chronic adnexal torsion and subsequent devascularization that precipitate infarction and necrosis. We describe a woman (Jehovah's witness) who presented with an inflamed abdominal cyst, which was diagnosed as an auto-amputated endometrial ovarian cyst, following laparoscopic surgery.

Case presentation: A 45-year-old Jehovah's witness was referred to our hospital with acute abdominal pain. She had complained of dysmenorrhea prior to referral. Laboratory data revealed evidence of severe inflammation (white blood cell count 12400 cells/μL, C-reactive protein 17.4 mg/dL).

  MRI revealed a cystic pelvic tumor with features of a benign ovarian cyst. She received intravenous antibiotics with resolution of inflammation following this conservative therapy after which we performed laparoscopic surgery for removal of the pelvic mass. Intraoperatively, we performed careful adhesiolysis followed by meticulous exploration of the pelvic cavity. We performed cystectomy and left adnexectomy with insertion of multiple drains into the peritoneal cavity.

Discussion: Based on the laparoscopic and histopathological findings, the patient was diagnosed with chemical panperitonitis associated with a wandering ovarian endometrial cyst.

Conclusion: We report successful but significantly challenging laparoscopic intervention for a wandering ovarian endometrial cyst in a woman with chemical peritonitis.