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Background
Paraovarian/paratubal cysts constitute about 10% of adnexal masses and are usually small and asymptomatic. A huge paratubal cyst complicated by adnexal torsion is a rare cause of acute low abdominal pain.
Case Report
We report the case of an obese 31-year-old nulliparous woman who presented with a large pelvic cyst causing ovarian torsi...
Context in source publication
Context 1
... analysis and pregnancy test were also negative. Because her pain worsened, despite the administration of analgesic drugs, the patient underwent an abdominal and pelvic computed tomography (CT) scan, which showed a huge central abdominal-pelvic cyst arising from the right adnexa ( Figure 1). The cyst measured 25 cm × 20 cm × 14 cm and there was an adjacent enlarged oedematous ovary, highly suggestive of torsion. ...
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Citations
... Paraovarian cyst is one type of benign non-neoplastic cysts in female adnexa, accounting for about 10% of adnexal masses [8]. It is a cyst with a single-layered wall and contains fluid. ...
Purpose
Paraovarian cysts in children and adolescents can be challenging to accurately diagnose prior to surgery. Our objective is to outline the clinical characteristics of paraovarian cysts and enhance the precision of diagnosing paraovarian cysts in this age group.
Methods
We retrospectively analyzed all patients with paraovarian cysts who underwent surgery in our department from 2013 to 2021. The review focused on demographic characteristics, clinical manifestations, intraoperative findings, and postoperative pathology of these patients.
Results
This cohort was composed of 38 children with paraovarian cysts. The average diameter of the cysts was 4.8 cm (range 0.5-10 cm). Among the cases, 25 (65.8%) had adnexal torsion. Postoperative pathology showed that all cases were simple cysts with serous fluid. After the procedure, the patients were monitored for a period ranging from 12 to 108 months. B-ultrasound and physical examination did not reveal any significant abnormalities.
Conclusions
B-ultrasound can help diagnose paraovarian cysts by detecting slight deviation movement between the cyst and the uterus. The presence of adnexa torsion in children and adolescents with paraovarian cysts does not depend on BMI, but rather on the size of cysts. Laparoscopic cyst removal has proven to be an effective surgical approach with favorable outcomes.
... However, these cysts can become complicated by torsion, hemorrhage, or infection. Paratubal cysts are frequently misidentified as ovarian masses and can be a common cause of tubal torsion [8]. Isolated fallopian tube torsion (IFTT), a rare condition characterized by the torsion of the fallopian tube without associated ovarian torsion, can occur during pregnancy [9]. ...
Abdominal pain in pregnant individuals presents diagnostic challenges, especially when appendicitis is suspected. We report a rare case of a 26-year-old pregnant female with recurrent right lower quadrant (RLQ) abdominal pain initially misdiagnosed as a urinary tract infection. Diagnostic uncertainty led to a magnetic resonance imaging (MRI) scan, which revealed a right adnexal cystic structure and a thickened tubular structure adjacent to the cecal pole, raising concerns of complicated appendicitis. Subsequent diagnostic laparoscopy revealed a right-sided fallopian tube paratubal cyst with 360-degree torsion and associated fallopian tube torsion without the involvement of the ovary. The cyst was successfully excised, and the patient subsequently delivered a healthy baby via emergency lower section caesarean section.
Abdominal pain during pregnancy has various causes. Diagnosing appendicitis during pregnancy is challenging due to anatomical and physiological changes. Ultrasound (US) is commonly used but has limited accuracy. Computed tomography (CT) is avoided due to radiation risks, while MRI is increasingly used and shows high diagnostic accuracy or aids in alternative diagnoses. Regardless of the diagnosis, the prompt recognition of intraabdominal pathology is crucial to prevent fetal morbidity.
This case highlights the challenges in the accurate diagnosis of abdominal pain during pregnancy and emphasizes the importance of considering alternative pathologies to prevent delays in treatment and complications. Clinicians should consider diagnostic laparoscopy for pregnant patients with equivocal investigations and lower abdominal pain. The differential diagnosis may include both common and rare causes such as concomitant paratubal cyst and isolated fallopian tube torsion (IFTT), emphasizing a high index of suspicion and collaboration with obstetric colleagues to ensure optimal care.
... Laparoscopy is the preferred approach for diagnosis and treatment of adnexal torsion (12), but laparotomy was decided for the present patient due to the technical difficulties associated with trocar insertion in the third trimester and the unavailability of an experienced laparoscopic surgeon in an emergency (12). ...
... All the cases were reported by physicians working in University Hospitals from many countries in the world: Turkey, 11,20,26,27 India, 2,10,12,15,28 Serbia, 29 Austria, 22 Spain, 30 Egypt, 31 Italy, 5 United States of America, 16 South Korea, 25,32 Japan, 23 Romania, 19 Lebanon, 13 Portugal, 33 Jordan, 14 Nepal, 34 Bosnia and Herzegovina, 24,35 Indonesia, 1 and Oman. 3 ...
... Complicated POCs have clinical features similar to acute appendicitis, complicated ovarian cyst, ectopic pregnancy or pelvic inflammatory disease. 11,33,48 Although the incidence of POCs in children is lower than in adults, the torsion rate seems to be higher due to a longer and looser infundibulopelvic ligament. 40,49 The present literature review found 11.1% (n = 3) cases of torsioned giant POCs, 29,30,33 only one case being in a pediatric patient. ...
... 11,33,48 Although the incidence of POCs in children is lower than in adults, the torsion rate seems to be higher due to a longer and looser infundibulopelvic ligament. 40,49 The present literature review found 11.1% (n = 3) cases of torsioned giant POCs, 29,30,33 only one case being in a pediatric patient. 29 Another potential complication is malignancy, with a reported incidence of 2.9%, mostly in adult patients. ...
Paraovarian cysts (POCs) develop within the broad ligament of the uterus. POCs are considered to be giant when the threshold of 150 mm is exceeded. Clinical signs and symptoms occur as a consequence of the pressure effect on adjacent organs or due to complications. Abdominal ultrasonography, computed tomography or magnetic resonance imaging are useful imaging tools, but most often the exact origin of such voluminous cysts is revealed only by surgical exploration. The review aims to appraise and update the diagnostic, the histological aspects and the treatment of the giant POCs in rare cases. We carried out a systematic search in Medline-PubMed, Google Scholar and ResearchGate electronic databases. Twenty-seven papers fulfilling the selection criteria were included in the review. The data extracted included information about first author, year of publication, country, patient age, size and side of the POCs, symptoms, tumoral markers, imaging methods, preoperative diagnosis, surgical management and histopathological findings. Although not very numerous, all the studies highlighted the low incidence of giant POCs, the impossibility of establishing the origin of the cystic mass by clinical and imaging methods even with advanced technical tools and the low risk of torsion (11.1%). Despite the recognized benign nature of POCs, we found an unexpected high percent (25.9%) of borderline giant POCs. Surgical excision is the only treatment option. Ovarian-sparing surgery was performed in 85.1% of the cases, and minimally invasive techniques were applied in only 42.9% of the patients, which demonstrates the need of a high-level laparoscopic expertise. Knowledge of this pathology, its recognition as a possible etiology of an abdominopelvic cyst, and a higher awareness of the possibility of a borderline histology in giant POCs are required for the proper management of these particular cases.
... Approximately 60% of them are benign [cystadenoma] in nature, 10% are borderline, and 30% are malignant [cystadenocarcinoma] in nature. Ovarian cysts can occur at any age, but they are most common during pubescence, a hormonally active period in girls' development [1] . ...
Objective: Ovarian cysts are a very common gynecological problem in adolescents and teenagers. The majority of ovarian cysts are benign, with only a small percentage of cases progressing to malignancy. Ovarian serous cystadenoma is uncommon in children, and it can progress to benign or malignant papillary serous tumors with oncological changes.Case report: The 18-year-old female patient arrived at the clinic complaining of abdominal heaviness and pain. Some cystic non-mobile mass was palpable up to 6cm above the umbilical level on abdominal examination. On ultrasonographic examination, a cystic mass measuring 17 x 10 x 8 cm was discovered in the right ovary and was not seen separately; a 7 x 6 cm cystic swelling was discovered in the left ovary. Serum CEA and CA 125 levels were measured and found to be 1.29 and 14.9, respectively, for further onco analysis, both of which were within normal limits. The tube was gently separated from the mass using a skilled surgical technique, and the cystic mass from both ovaries was removed. The cystic masses were sent for histopathological examination, which revealed that they were benign papillary serous tumors.Conclusion: A benign papillary serous tumor in a teenage girl is a rare and difficult finding. Cysts are common, but papillary serous tumors are unusual. Careful USG and early diagnosis of such cysts, as well as skillful surgical removal of such cysts, can improve the quality of life in teenagers.
... On CT, benign paratubal cysts appear as thin-walled unilocular cysts with a smooth capsule containing clear fluid. 3,8,15 On magnetic resonance imaging, benign paratubal cysts appear as a thin-walled unilocular cyst with smooth borders. 5 Imaging of non-benign paratubal cysts may show intramural solid nodules, papillary projections, or a septum inside the cyst. ...
Paratubal cysts may mimic ovarian cysts, and most of them are diagnosed postoperatively. They originate from the mesosalpinx between the ovary and the fallopian tube. Only a few are large, and most paratubal cysts are less than 10 cm. We report a huge paratubal cyst in a 30-year-old woman, whose only preoperative complaint was abdominal distention over 4 months. Conservative surgery was performed with cyst removal while preserving the ovaries and tubes. A paratubal cyst should be included in the differential diagnosis of a large pelvic masses, especially in the reproductive age.
... Giant cysts as large as 25 cm have been reported in the literature and are a rare cause abdominoelvic pain secondary to haemorrhage, rupture or torsion. 4 Paratubal cysts account for 10% of reported ovarian masses and are the second most common cause of tubal torsion behind ovarian cysts. [4][5][6] Isolated fallopian tube torsion (IFTT) occurs when the fallopian tube undergoes torsion without concomitant ovarian torsion. ...
... 4 Paratubal cysts account for 10% of reported ovarian masses and are the second most common cause of tubal torsion behind ovarian cysts. [4][5][6] Isolated fallopian tube torsion (IFTT) occurs when the fallopian tube undergoes torsion without concomitant ovarian torsion. 7 The most common presentation is unilateral lower abdominal or flank pain with tenderness on palpation. ...
Paratubal cysts are fluid-filled sacs that grow adjacent to the fallopian tube which can rarely result in torsion. Isolated fallopian tube torsion (IFTT) is a gynaecological emergency that warrants urgent laparoscopic detorsion to salvage the affected tube. IFTT has a proclivity to affect adolescents between the ages of 12 and 15 years and is rarely seen in premenarchal or perimenopausal women. Due to a lack of pathognomonical features, IFTT is difficult to diagnose. Adnexal torsion, including IFTT is a surgical diagnosis and no clinical or imaging criteria is sufficient to diagnose IFTT. Urgent laparoscopy and detorsion are required for preservation of the affected fallopian tube. However, given the diagnostic ambiguity, IFTT diagnosis is often delayed. IFTT should be included in the differential diagnoses for adolescent patients with acute abdomen when imaging demonstrates a normal appendix and ovaries. We report a 15-year-old girl with a 4-day history of abdominopelvic pain and bilateral paratubal cysts resulting in right IFTT.
Paraovarian or paratubal cysts are located between the ovary and the fallopian tube. They are usually benign and paratubal cysts are defined as a giant when they cross the 150 mm threshold. Open surgery is generally preferred in large cysts due to the difficulty of exploration. In our case, the size of the cyst was reduced by evacuating the transabdominal, and it was made easy to visualize. The cyst capsule was detached, the overlying tube was left intact, and fertility preservation was achieved.
Résumé
Les kystes paratubaires constituent environ 10 % des masses annexielles et sont généralement petits et asymptomatiques. Un kyste paratubaire, très volumineux, compliqué par une torsion annexielle est une cause peu commune de douleur pelvienne. Nous présentons le cas d’une femme nullipare de 20 ans amenée aux urgences à cause des douleurs pelviennes aiguës, avec à l’exploration chirurgicale une torsion annexielle sur un kyste paratubaire. Nous précisons à travers cette observation, ses aspects épidémiologiques, cliniques et radiologiques.
