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Laparoscopic management of a large, twisted, ovarian dermoid cyst during pregnancy: a case report.

BACKGROUND
Mature cystic teratomas, commonly known as dermoid cysts, are the most frequent ovarian tumors discovered during pregnancy. They are present in 0.3% of pregnancies from weeks 16-20 of gestation. The diagnosis of mature cystic teratomas during pregnancy presents the vexing problem of weighing the risks of surgery under general anesthetic against the risks of an untreated persistent adnexal mass.


CASE
We present the case of an 18-year-old woman, gravida 1, in her 18th week of pregnancy who was referred to our center with severe abdominal pain and nausea. The diagnosis of torsion of a dermoid cyst 15 cm in diameter was made. The patient underwent laparoscopy under general anesthesia and the cyst was successfully removed intact. This was enabled by the endobag technique, thus preventing spillage of the cyst content into the peritoneal cavity. The fetus tolerated surgery well with no complications.


CONCLUSION
In the case of an adnexal mass in pregnancy, surgery should be taken into consideration if the mass is > 5-6 cm. The data suggest that, given the availability of an experienced laparoscopic surgeon, laparoscopy should be considered, and in cases in which there is no emergency, elective surgery should be scheduled in the late first or, preferably, early second trimester if possible.