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Abstract: A female patient came to the clinic, reporting abdominal pain 5 days ago, which worsened after toileting and could not be improved after rest, and continued until now, and worsened at night, even with symptoms of nausea and vomiting, which seriously affected normal life, and therefore came to the clinic. CT examination was performed, and the possibility of teratoma was considered, followed by specialist examination to clarify the diagnosis. Therefore, surgical treatment was given, and the patient’s abdominal pain disappeared and her condition was controlled after the operation.
Basic information】Female, 31 years old
Type of disease】Unmature teratoma
Hospital】Shengjing Hospital of China Medical University
Date of consultation】July 2019
Treatment plan】Surgical treatment (laparoscopic right adnexal resection) + intravenous infusion (cefradine for injection, glucose injection)
Treatment period】7 days of hospitalization
【Treatment effect】The condition was controlled
I. Initial consultation
The patient is a 31-year-old woman who came to our hospital 5 days ago because she felt abdominal pain, which increased after going to the toilet, and thought it would improve after resting. Based on the patient’s clinical symptoms, we initially considered that the cause of abdominal pain might be related to teratoma and did not exclude the possibility of torsion. CT examination was given, and the results showed a mixed echogenicity in the right adnexal area, with a size of about 48×40×49mm, regular shape and clear boundary, and a mass of strong echogenicity was seen within it.
II. Treatment process
After the patient was admitted to the hospital, a specialist examination was performed to clarify the cause of abdominal pain. On vaginal exploration, the patient’s uterus showed no abnormal signal, mixed echogenicity was seen in the right adnexal region, and palpation revealed a palpable mass with a tough texture and no pain. The general examination showed that the patient’s vital signs were stable, no fever, blood pressure was within normal range of 121/19 mmHg, and heart rate was 75 beats per minute. Further review of the ultrasound indicated a cystic solid pelvic mass with a small amount of effusion and a cystic mass in the uterine cavity, which was consistent with the previous examination. After discussion with the patient, the patient agreed to undergo surgical treatment. Therefore, preoperative blood and urine routine, biochemistry, electrocardiogram, blood coagulation and other tests were completed, and after excluding contraindications to surgery, laparoscopic right adnexal resection was performed, and the specimen was also sent for pathological examination. After the operation, the patient was given cefradin anti-inflammatory injection and glucose injection for rehydration. The pathological examination returned a large part of the cystic wall tissue, focal fibrous tissue hyperplasia with hemorrhagic degeneration and small foci of cystic follicles, which was consistent with the diagnosis of ovarian immature teratoma.
III. Treatment results
On the 2nd postoperative day, the patient had the urinary catheter removed, resumed voluntary urination, and ate a liquid diet after the appearance of venting, and the patient’s incision site was dry and did not become infected. On the 3rd postoperative day, the patient was given a repeat blood test, and the hemoglobin was 127 g/L and the leukocyte was 4.82×10^9/L. The results did not show any significant abnormalities, and the incision site healed well. One week after admission, the patient’s abdominal pain disappeared completely, his vital signs were stable, the surgical site healed well, and no symptoms such as exudate and hard knots appeared.
IV. Notes
We are glad that the patient was discharged successfully after active treatment. However, since the patient was not completely cured at the time of discharge, the patient still needs to pay attention to the following points in daily life.
1, in life, pay attention to rest, avoid overwork, maintain healthy habits, avoid staying up all night, and at the same time maintain an optimistic attitude, avoid emotional tension, anxiety and other adverse emotions, it is recommended that patients participate in interest activities to relieve stress. In addition, patients need to keep the postoperative incision dry, avoid taking a tub bath and strenuous exercise in the early stage, and take a shower after the wound has healed, as well as appropriate exercise.
2. In terms of diet, increase nutritional intake, eat more foods rich in protein, such as milk, lean meat, eggs, etc., and eat more fresh vegetables and fruits rich in vitamins and fiber, such as cabbage, spinach, apples, bananas, etc., to prevent constipation symptoms.
V. Personal insight
Immature teratoma of the ovary is a malignant germ cell tumor of the ovary with a high degree of malignancy. It mainly has symptoms such as abdominal mass and abdominal pain, but does not affect menstruation and fertility in the early stage. The treatment of immature teratoma is not only surgical treatment but also early and effective combined chemotherapy, but in this case, the patient belonged to immature teratoma early stage can be observed and then the treatment plan can be formulated according to the condition, so chemotherapy was not carried out. Therefore, if there is unexplained abdominal pain and severe abdominal pain in daily life, it is important to pay attention to go to the hospital for differential diagnosis and symptomatic treatment in a timely manner, and it is also recommended that women have regular medical checkups for early detection and early treatment.