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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.

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