Torsed Ovarian Dermoid

Abstract

Ovarian dermoids constitute the most common ovarian neoplasm and make up approximately 20% of all ovarian neoplasms. Dermoids are most common in the reproductive age group, but unlike other ovarian germ cell tumors, their age distribution is quite broad. Torsion may occur in approximately 15% of cases and is more common during pregnancy and in the 6 weeks immediately after delivery. We present a 17-year-old who came to the emergency department in her puerperium with severe right lower quadrant pain. The diagnosis of a 12-cm dermoid was missed at ultrasound. We discuss the reasons for the mistake on ultrasound and give strategies to prevent this from happening in the future. Three commonly overlooked teaching points regarding dermoids are discussed. Ultrasound and computed tomographic imaging, operative course, and correlative intraoperative and pathological images are presented.