Cystic teratoma-provoked peritonitis after pregnancy termination

Cystic teratoma is an unusual cause of postabortal pelvic peritonitis.

A healthy 22-year-old woman underwent outpatient first-trimester vacuum pregnancy termination, followed by a 3-day course of oral doxycycline. On the thirteenth day after pregnancy termination, she presented with fever, an acute abdomen, and pelvic pain. The woman underwent re-aspiration of her uterus, which yielded scanty tissue. She then underwent pelvic ultrasound and computerized tomogram, both of which revealed a posterior pelvic mass, presumed to be an abscess. After 5 days of broad-spectrum antibiotics had failed to alleviate her fever and pain, culdocentesis was performed yielding 30 cm3 of pus, hair, and fat. The woman underwent laparotomy, which revealed a 10 x 8 x 5 cm multiloculated, infected benign cystic teratoma with extensive capsular adhesions.

If postoperative infection is to develop after pregnancy termination, signs will usually appear within the first week. Onset of pelvic peritonitis more than 1 week after uneventful conclusion of a pregnancy event should raise suspicion of either non-gynaecologic causes or, as in this case, a pelvic neoplasm.