Torsion of a paraovarian cyst on the fallopian tube: Case report

Abstract

INTRODUCTION AND IMPORTANCE: Paraovarian cysts are benign adnexal lesions that typically remain asymptomatic but can lead to serious complications such as torsion, resulting in ischemia and necrosis. Torsion involving the fallopian tube is a rare gynecological emergency requiring prompt diagnosis and intervention. This case report highlights the clinical presentation, diagnostic challenges, and management of a 28-year-old woman with paraovarian cyst torsion leading to fallopian tube necrosis. CASE PRESENTATION: A 28-year-old woman presented to the emergency department with acute-onset severe right lower abdominal pain, nausea, and vomiting. Clinical examination revealed right lower quadrant tenderness and peritoneal signs. Transvaginal ultrasound with Doppler imaging identified a 5 cm adnexal cyst with thickened walls and diminished vascularity, raising suspicion of adnexal torsion. Emergency laparoscopic exploration was performed for definitive diagnosis and management. Laparoscopy confirmed torsion of a paraovarian cyst involving the right fallopian tube, with complete necrosis of both structures. The ovary appeared unaffected. A right salpingectomy and cyst excision were performed. Histopathological examination confirmed the diagnosis of a necrotic paraovarian cyst with ischemic changes in the fallopian tube. The patient had an uneventful postoperative recovery and was discharged on the second day. At the one-month follow-up, she reported complete resolution of symptoms without complications. CLINICAL DISCUSSION: This case underscores the diagnostic challenges of paraovarian cyst torsion, which often mimics other acute abdominal conditions. Although rare, with an estimated prevalence of 2-3 % among adnexal masses, paraovarian cysts can significantly impact quality of life when complications like torsion occur. Imaging, particularly transvaginal ultrasound with Doppler, plays a critical role in raising suspicion, but laparoscopy remains the gold standard for definitive diagnosis and treatment. Early surgical intervention is essential to prevent irreversible tissue damage and preserve ovarian function, particularly in women of reproductive age. CONCLUSION: Paraovarian cyst torsion is a rare but serious condition that requires a high index of suspicion and prompt surgical management. Laparoscopic intervention is effective for both diagnosis and treatment, ensuring favorable outcomes and preserving fertility. Clinicians should consider this diagnosis in women presenting with acute abdominal pain and adnexal pathology on imaging.