Laparoscopic Removal of a Retroperitoneal Teratoma Presenting as Epigastric Pain

Jonah J Stulberg, MD, PhD, MPH, Robert Parry, MD, Todd A Ponsky, MD, Mark O McCollum, MD. 1. University Hospitals, Case Medical Center, Department of Surgery, 11100 Euclid Avenue, Cleveland, OH 44106. 2. MetroHealth Medical Center, Division of Pediatric Surgery, 2500 MetroHealth Drive, Cleveland, OH 44109.

Introduction: Teratomas are a relatively common tumor seen in children. Most of these occur within the ovary. However, there are many reports in the literature of extraovarian teratomas. Here we report a case of a retro gastric, peri-pancreatic teratoma in an adolescent female that we removed laparoscopically.

Case: The patient was an 11 year old female who had been treated for gastritis and gastroesophageal reflux disease for generalized abdominal discomfort for years without relief. A plain radiograph of her abdomen identified a calcified mass in her right upper quadrant (RUQ) and subsequent ultrasound found a normal appearing gallbladder, liver and biliary tree. A CT scan was therefore performed and she was found to have a 3 cm retroperitoneal calcified mass consistent with a teratoma versus partially calcified lymphangioma. The decision was made to perform a laparoscopic exploration and possible excision of the mass. One 12 millimeter umbilical port and two 5 millimeter ports were inserted. The lesser sack was entered by dividing the gastrocolic ligament and the mass was removed from the surrounding retroperitoneum without complication. The patient had an uneventful post-operative course and was discharged home tolerating a regular diet on post-operative day two. The mass was found to be a cystic teratoma on final pathologic specimen.

Conclusion: This case and associated video demonstrates a unique presentation of a peri-pancreatic teratoma and the feasibility of laparoscopic excision.

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