A large Parasitic Dermoid Cyst in the Pouch of Douglas: a Torsion Complication?

Abstract

A large Parasitic Dermoid Cyst in the Pouch of Douglas: a Torsion Complication? Kista demoid pada Pouch of Douglas: Apakah sebuah komplikasi torsio? Luay I. A. Atileh 1 , Nouf M. Khalifeh 2 1 Department of Obstetrics and Gynecology, Albasheer Hospital, Jordan Ministry of Health, Amman, Jordan. 2 Arizona State University, Arizona, United States of America Abstract Abstrak Objective: To identify the underlying etiology of dermoid cysts in the pouch of Douglas. Tujuan: Untuk mengidentifi kasi etiologi yang mendasari kista dermoid di kantong Douglas. Methods: Case report. Case: A 44-year-old woman presented to our clinic complaining of chronic, dull-aching lower abdominal pain of one-month duration. Pelvic ultrasound examination showed an eight-centimeter cystic appearing lesion in the right adnexa. Computed tomography (CT) suggested the diagnosis of dermoid cyst. Laparoscopy revealed a residual ovarian tissue on the right side and an eight-centimeter cystic mass occupying the pouch of Douglas. The entire specimen was removed en bloc through the umbilicus incision inside a bag with no spillage. Histopathologic examination confi rmed the diagnosis of a mature cystic teratoma. Conclusions: Parasitic dermoid cysts are extremely rare entity especially those located in the pouch of Douglas. Autoamputation and reimplantation is the most accepted etiology to explain this phenomenon. Keywords: autoamputation, dermoid cyst, douglas, laparoscopy, mature cystic teratoma. Metode: Laporan kasus Kasus : Seorang perempuan 44 tahun datang ke klinik kami dengan keluhan nyeri perut bagian bawah yang kronis dan nyeri tumpul selama satu bulan. Pemeriksaan USG panggul menunjukkan lesi kistik delapan sentimeter yang muncul di adneksa kanan. Computed tomography (CT) menyarankan diagnosis kista dermoid. Laparoskopi mengungkapkan jaringan ovarium sisa di sisi kanan dan massa kistik delapan sentimeter menempati kantong Douglas. Seluruh spesimen dikeluarkan secara en bloc melalui sayatan umbilikus di dalam kantong tanpa tumpahan. Pemeriksaan histopatologi mengkonfi rmasi diagnosis teratoma kistik matur. Kesimpulan: Kista dermoid parasit adalah entitas yang sangat langka terutama yang terletak di kantong Douglas. Autoamputasi dan reimplantasi adalah etiologi yang paling diterima untuk menjelaskan fenomena ini. Kata kunci: autoamputasi, douglas, kista dermoid, laparoskopi, teratoma kistik matur.