Ruptured Ovarian Mature Teratoma in a Pregnant Woman with Severe Chemical Peritonitis: A Case Report

BACKGROUND Mature cystic teratomas (MCTs) account for about 25% of ovarian lesions. They are usually asymptomatic, but can complicate pregnancies if they lead to ovarian torsion or chemical peritonitis due to spontaneous rupture. CASE REPORT A 31-year-old woman who was gravida 4, para 1, aborta 1 at 26 weeks 0 days gestation presented with nonspecific, severe, acute-onset abdominal pain, which persisted despite conservative measures. Initial imaging showed a pelvic fluid collection and she was taken for a diagnostic laparoscopy, which showed purulent fluid in her pelvis. While the differential diagnosis included acute appendicitis and ruptured tubo-ovarian abscess, the source of the pain was determined to be a ruptured mature cystic teratoma. CONCLUSIONS A ruptured MCT is a reasonable addition to the differential diagnosis for pelvic pain in pregnancy. A pelvic washout during a diagnostic laparoscopy is an ideal way to manage the chemical peritonitis due to a spontaneously ruptured MCT.