Isolated torsion of paraovarian cyst: a case report with review of literature

Isolated torsion of paraovarian cyst: a case report with review of literature DOI: https://doi.org/10.18203/2320-1770.ijrcog20260208Keywords: Paraovarian cyst, Fallopian tube, Acute abdomen, Laparoscopy, CystectomyAbstract Paraovarian cyst (POC) develops in the mesosalpinx, between the fallopian tube and the ipsilateral ovary. The incidence is 02-03% of adnexal masses and torsion occurs in about 01% of acute abdomen in women with adnexal mass. It is common in reproductive age and originates from the mesothelium or the embryonic remnant of Müllerian or Wolffian duct. The cyst is usually benign, unilateral, sessile, unilocular, small size and asymptomatic. The patient may be asymptomatic or present with chronic pain when a POC increases in size or with an acute abdomen when it develops complications like torsion, hemorrhage, rupture, or malignancy. Diagnosis is difficult, and surgical exploration is the gold standard for diagnosis and management. We present a case of 24-year-old unmarried girl with dull pain abdomen off and-on-and low back pain for three months is more so for last 3 days without gastrointestinal or urinary symptoms or menstrual abnormality. Infective origin was excluded clinically and on blood count. Ultrasound revealed a cystic lesion in the left adnexa likely to be a simple ovarian cyst. She developed acute abdomen features later, and laparoscopy revealed a torsion left POC of 10×10 cm. De-torsion and cystectomy were performed, and histopathology reported a benign POC of paramesonephric origin. Rare incidence and challenging diagnosis must be kept in mind in acute abdomen with adnexal mass, and surgical exploration should not be delayed. The presentation aims to report the rare pathology and Laparoscopy as the gold standard for diagnosis and management. Metrics References Tzur T, Tzur Y, Baruch S, Smorgick N, Melcer Y. Clinical Presentation of Paraovarian Cysts. Isr Med Assoc J. 2022;24(1):15-9. 2. Sohrabi C, Mathew G, Maria N, Kerwan A, Franchi T, Agha RA; Collaborators.The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2023;109(5):1136-40. DOI: https://doi.org/10.1097/JS9.0000000000000373 Kiseli M, Caglar GS, Cengiz SD, Karadag D, Yilmaz MB. Clinical diagnosis and management of paraovarian cysts in adolescents: a case series. J. Pediatr. Adolesc. Gynecol. 2019; 32(3):319-22. Gedam JK, Rajput DA, Bhalerao MV. Torsion- of para-ovarian cyst resulting in secondary torsion of the fallopian tube: a cause of acute abdomen. J Clin Diagn Res. 2014;8(5):OD10-1. DOI: https://doi.org/10.7860/JCDR/2014/7946.4386 Puri M, Jain K, Negi R. Torsion of para-ovarian cyst: a cause of acute abdomen. Indian J Med Sci. 2003;57(8):361-2. Vlahakis-Miliaras E, Miliaras D, Koutsoumis G, Miliaras S, Spyridakis I, Papadopoulos MS. Paratubal cysts in young females as an incidental finding in laparotomies performed for right lower quadrant abdominal pain. Pediatr Surg Int. 1998;13(2-3):141-2. DOI: https://doi.org/10.1007/s003830050268 Genadry R, Parmley T, Woodruff JD. The origin and clinical behavior of the Paraovarian tumor. Am J Obstet Gynecol. 1977;129(8):873-80. DOI: https://doi.org/10.1016/0002-9378(77)90520-8 Kiran S, Jabri SS, Razek YA, Devi MN. Non-Tender Huge Abdominal Mass in an Adolescent: Bilateral paraovarian cysts. Sultan Qaboos Univ Med J. 2021;21(2):e308-11. DOI: https://doi.org/10.18295/squmj.2021.21.02.022 Hillaby K, Aslam N, Salim R, Lawrence A, Raju KS, Jurkovic D. The value of detection of normal ovarian tissue (the 'ovarian crescent sign') in the differential diagnosis of adnexal masses. Ultrasound Obstet Gynecol. 2004;23(1):63-7. DOI: https://doi.org/10.1002/uog.946 Durairaj A, Gandhiraman K. Complications and Management of Paraovarian Cyst: A Retrospective Analysis. J Obstet Gynaecol India. 2019;69(2):180-4. DOI: https://doi.org/10.1007/s13224-018-1152-2 Gupta A, Gupta P, Manaktala U, Khurana N. Clinical, radiological, and histopathological analysis of paraovarian cysts. J Midlife Health. 2016;7(2):78-82. DOI: https://doi.org/10.4103/0976-7800.185337 Takeda A, Kitami K, Shibata M. Magnetic resonance imaging and gasless laparoendoscopic single-site surgery for the diagnosis and management of isolated tubal torsion with a paratubal cyst at 31 weeks of gestation: A case report and literature review. J Obstet Gynaecol Res. 2020;46(8):1450-5. DOI: https://doi.org/10.1111/jog.14252 Dotters-Katz SK, James AH, Jaffe TA. Paratubal /Paraovarian Masses: A Study of Surgical and Non-Surgical Outcomes. Med J Obstet Gynecol. 2014;2(1):1019. Stein AL, Koonings PP, Schlaerth JB, Grimes DA, d'Ablaing G 3rd. Relative frequency of malignant parovarian tumors: should parovarian tumors be aspirated? Obstet Gynecol. 1990;75(6):1029-31. Korbin CD, Brown DL, Welch WR. Paraovarian cystadenomas and cystadenofibromas: Sonographic characteristics in 14 cases. Radiology. 1998;208:459-62. DOI: https://doi.org/10.1148/radiology.208.2.9680576