Small bowel necrosis and enterocutaneous fistulae resulting from iatrogenic spillage of dermoid cyst contents at the time of laparoscopic surgery

Abstract

A 38-year-old lady with a 14×8×13-cm dermoid cyst underwent a laparoscopic left salpingo-oophrectomy. Intra-operatively, there was accidental spillage of the cyst contents into the peritoneal cavity. The spilled contents were completely sucked out and a thorough peritoneal lavage was done to decrease the risk of chemical peritonitis. The patient developed disseminated granulomatous chemical peritonitis, small bowel necrosis, multiple enterocutaneous fistulae, intra-abdominal, and anterior abdominal wall abscesses. Following four further surgeries, she finally made a recovery 6 months later. Chemical peritonitis and intra-abdominal abscesses are rare complications. Bowel necrosis and enterocutaneous fistulae have not been described. This case report will increase awareness of these rare complications and in their prevention and management. A literature review of strategies to prevent spillage of dermoid cyst contents at surgery is also presented. © Springer-Verlag 2008.