naa a22 4500 510814050 CHVBK 20180411083456.0 cr unu---uuuuu 180411e20130801xx s 000 0 eng 10.1007/s12328-013-0391-0 doi (NATIONALLICENCE)springer-10.1007/s12328-013-0391-0 A case of chemical peritonitis and pleuritis caused by spontaneous rupture of a benign cystic ovarian teratoma that improved without surgical intervention [Elektronische Daten] [Kazuaki Tejima, Runa Enomoto, Toru Arano, Jun Miwa, Yasuo Matsubara, Jun Tashiro, Daisuke Tagami, Hikaru Kakimoto, Masahito Takahashi, Shirika Higa, Akira Suzuki, Masahiro Arai] Rupture of a benign cystic ovarian teratoma may result in severe chemical granulomatous peritonitis, a condition mimicking peritonitis carcinomatosa, with patients complaining of common abdominal symptoms. As the precipitating cause of rupture is often indeterminate and the rupture itself is hard to recognize, it is difficult to differentiate from peritonitis of other etiologies, such as gastrointestinal malignancy. We report the case of a 72-year-old female who presented with recurrent pyrexia and abdominal distension. Laboratory data showed signs of inflammation and a high level of carbohydrate antigen 125. Imaging examinations showed left-side-dominant pleural effusion, ascites with peritoneal adhesions, and a left cystic ovarian teratoma. Repeat paracentesis of both the pleural effusion and ascites demonstrated exudative characteristics, but there was no indication of malignancy or signs of infection, including those of tuberculosis. Although exploratory laparotomy was then recommended for conclusive diagnosis and ruling out such gynecological malignancy, the patient declined. Fortunately, laboratory data, radiological images, and other clinical findings gradually improved over the following 12months. Moreover, a retrospective review of the computed tomography images revealed lipid particles in the ascites, indicative of teratoma rupture. The final diagnosis was chemical peritonitis and pleuritis caused by spontaneous rupture of the benign cystic teratoma. The present case was extremely rare with regard to its diagnosis and clinical progression. Our experience suggests that chemical peritonitis should be included in the differential diagnosis of peritonitis. Springer Japan, 2013 Benign cystic ovarian teratoma nationallicence Chemical peritonitis nationallicence Granulomatous peritonitis nationallicence Spontaneous rupture of teratoma nationallicence CEA : Carcinoembryonic antigen nationallicence CA19-9 : Carbohydrate antigen 19-9 nationallicence CA125 : Carbohydrate antigen 125 nationallicence sIL-2R : Soluble interleukin 2 receptor nationallicence ADA : Adenosine deaminase nationallicence PCR : Polymerase chain reaction nationallicence WBC : White blood cells nationallicence Tejima Kazuaki Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Enomoto Runa Department of Gastroenterology, Tokyo Medical and Dental University, University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan aut Arano Toru Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Miwa Jun Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Matsubara Yasuo Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Tashiro Jun Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Tagami Daisuke Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Kakimoto Hikaru Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Takahashi Masahito Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Higa Shirika Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Suzuki Akira Department of Obstetrics and Gynecology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Arai Masahiro Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut Clinical Journal of Gastroenterology Springer Japan 6/4(2013-08-01), 274-280 1865-7257 6:4<274 2013 6 12328 https://doi.org/10.1007/s12328-013-0391-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12328-013-0391-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tejima Kazuaki Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Enomoto Runa Department of Gastroenterology, Tokyo Medical and Dental University, University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan aut NATIONALLICENCE 700 1- Arano Toru Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Miwa Jun Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Matsubara Yasuo Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Tashiro Jun Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Tagami Daisuke Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Kakimoto Hikaru Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Takahashi Masahito Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Higa Shirika Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Suzuki Akira Department of Obstetrics and Gynecology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 700 1- Arai Masahiro Department of Gastroenterology, Toshiba General Hospital, 6-3-22 Higashiooi, Shinagawa-ku, 140-8522, Tokyo, Japan aut NATIONALLICENCE 773 0- Clinical Journal of Gastroenterology Springer Japan 6/4(2013-08-01), 274-280 1865-7257 6:4<274 2013 6 12328 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer