ACUTE GYNAECOLOGICAL EMERGENCY CAUSED BY RUPTURED DERMOID

Benign dermoid cyst makes up 10 to 15 percent of all ovarian tumors and tends to occur at a relatively early age. Dermoid cysts are bilateral in 12 percent of cases. Cystic teratomas and mucinous cystadenoma may often coexist in the same ovary. A dermoid cyst rarely grows beyond the size of a melon. The lining epithelium is stratified squamous and the cyst contains sebaceous material within, they also contain ectodermal elements like sebaceous glands, hair follicles and sometimes teeth. There is no specific tumor marker in clinical practice for dermoid tumor. CA 125 elevation in seen with epithelial ovarian tumor. CA 19-9 is elevated in mucinous ovarian malignancy and in gastrointestinal cancers. CEA levels higher than 5mg/L are seen elevated in mucinous cancers. Rupture of dermoid cyst is usually spontaneous but may occur from trauma or during labor, coitus or pelvic examination. Rupture is more likely if the wall of the cyst is already damaged by previous ischemic degeneration, if the cyst is papilliferous in type or if it is malignant. It presents with acute pain with the feeling of give away. There may be signs of peritoneal irritation.