Late and severe hyperemesis gravidarum caused by an obstructive teratoma

Summary

A 34-year old primigravid woman presented at 24 weeks of gestation in labour-ward with persistent and severe vomiting since early pregnancy. This was associated with right upper quadrant pain and difficulties in bowel motions. On ultrasound examination a large isoechogenic, homogenic and well-demarcated lesion of about 10 x 12 cm was seen adjacent to the pregnant uterus. Doppler studies were normal. Fetal ultrasound showed a healthy and normally developed fetus. There was no threatened preterm labour.

The bloods showed a slight leukocytosis with mildly elevated pancreatic enzymes.

No gastrointestinal cause could be found for her symptoms. An MRI was performed so as to clarify the origin of this abdominal structure seen on ultrasound. The mass was seen to arise from the right fallopian tube and was pushing on the pylorus and the duodenum, giving rise to a mechanical subileus. Hence, it was thought to be a heterotopic pregnancy or a teratoma.

The lesion was removed laparoscopically. The patient could be discharged home after surgery and the pregnancy continued uneventfully. Histological examination showed a cystic mature ovarian teratoma.

This is a very rare case of a non-pregnancy related cause of upper abdominal symptoms exacerbated by pregnancy.

Publication History

Article published online:
20 June 2022