Management of Adnexal torsion on a paratubal cyst- A case report

Paratubal cysts are common adnexal lesions, generally under 6 cm in size. Although mostly benign, rare cases of malignant transformation into adenocarcinomas have been reported. Complications include rupture, hemorrhage, and occasionally adnexal torsion. This case report involves an 18-year-old woman presenting with right-sided adnexal torsion caused by a paratubal cyst.

The patient, with no significant medical history, presented with acute right pelvic pain and vomiting. She was tachycardic with marked tenderness in the right iliac fossa. Ultrasound revealed a 6 cm right paratubal cyst and signs of adnexal torsion. Surgery confirmed a 5 cm paratubal cyst with adnexal torsion. The histopathology report confirmed a benign paratubal cyst.

Paratubal cysts represent 5-20 % of adnexal masses, developing from embryonic remnants. Some can become very large and have a small risk of malignant transformation. Complications like rupture, hemorrhage, or torsion can present as acute, or gradually worsening pelvic pain, sometimes with gastrointestinal symptoms. Ultrasound is often the first imaging choice, revealing a cystic mass and potential signs of torsion. Doppler ultrasound can aid by showing spiral vessel patterns, though normal blood flow does not rule out torsion. In uncertain cases, MRI is valuable for detailed visualization. Surgical intervention, preferably via laparoscopy, is the standard treatment. Larger cysts may require a combined approach of laparoscopy for diagnostic purposes. Complete cystectomy is recommended to prevent malignant spread, with salpingectomy considered for severe tubal damage.

Paratubal cysts, while usually asymptomatic, can present with complications, especially torsion. Prompt diagnosis and management are essential to preserve fertility.