Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 57, Num. 8, 2003, pp. 361-362

Indian Journal of Medical Sciences, Volume 57, Number 8, August 2003, pp. 361-362

Case Report

Torsion of para-ovarian cyst: A cause of acute abdomen

Manju Puri, Kanika Jain, Rinku Negi

Department of Obstetrics and Gynecology, Lady Hardinge Medical College, 814, Asia House, Kasturba Gandhi Marg, New Delhi 110001, India.
Correspondance : Dr. Manju Puri, 814, Asia House, Kasturba Gandhi Marg, New Delhi 110001, India. Tel: 3388182 E-mail : purimanju@rediffmail.com

Accepted Date 10-07-2003

Code Number: ms03014

ABSTRACT

Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of fallopian tube has also been reported in literature. However, torsion of para ovarian cyst is a very rare. We report a rare case of twisted para ovarian cyst resulting in secondary torsion of the fallopian tube. Torsion of fallopian tube and para ovarian cyst are usually seen in the reproductive age group. Physicians need to maintain a high index of suspicion for this uncommon and often difficult to diagnose cause of abdominal pain.

INTRODUCTION

Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of fallopian tube has also been reported in literature.¹ However, torsion of para ovarian cyst is a very rare event.

We report a rare case of twisted para ovarian cyst resulting in secondary torsion of the fallopian tube.

CASE REPORT

A 41-year-old lady, para 1 with previous lower segment caesarean section done 16 years back presented with complaint of pain in the right iliac fossa since one day.The pain was spasmodic in nature, radiating to her back and was accompanied with giddiness and vomitings. There was no history of any fever, fainting attacks, bowel or urinary complaints. She had polymenorrhagia and history of dysmenorrhoea since the past 2 years. Her last menstrual period was 14 days back and she was not using any contraceptives.

On examination, patient's general condition was stable, she had mild pallor, was afebrile, her pulse rate was 96/min. regular, blood pressure was 120/80 mm Hg. and her hydration was fair. The per-abdominal examination was normal except slight tenderness in right iliac fossa. On per-speculum examination, cervix and vagina were healthy and there was no abnormal discharge. On per-vaginal bimanual examination, uterus was retroverted, bulky, firm, nontender and mobile. A tense, tender, cystic mass about 6x5 cms was felt separate from the uterus in anterior and right fornix. Left fornix was free. Cervical excitation pain was present.

Her haemoglobin was 10.6 g%, total leucocyte count was 11900/cumm, differential leucocyte counts were within normal limits and urine pregnancy test was negative. On ultrasonography, the uterus was bulky in size. There was an anechoeic cystic mass 6x6 cms in size seen on the right side of the uterus. Right ovary could not be visualized separately. Left ovary was cystic and measured 3x3 cms in size. There was no free fluid in POD. A provisional diagnosis of twisted right ovarian cyst was made.

Patient was taken up for diagnostic laparoscopy and proceed.

Per-operative findings revealed a bulky uterus which showed a bluish bulge on posterior wall near fundus,four cms in diameter. Bilateral ovaries and left tube were normal looking. Right sided fallopian tube had undergone torsion twice around it's pedicle and appeared distended and bluish black in colour. Decision for laparotomy was taken and total abdominal hysterectomy with right sided salpingectomy was performed. The post-operative period was uneventful. Histopathology revealed a twisted haemorrhagic para-ovarian cyst with an oedematous fallopian tube with haemorrhage in it's lumen and intensive adenomyosis with subserosal adenomyoma of the uterus.

DISCUSSION

Torsion of fallopian tube and para ovarian cyst are usually seen in the reproductive age group.² Being an uncommon surgical emergency with no definitive diagnostic signs the diagnosis is often delayed, resulting in irreversible damage to the fallopian tube.³ Awareness of this condition is warranted to suspect and reach at an early diagnosis and enable the surgeon to perform a conservative surgery and salvage the fallopian tube. Several authors advocate detorsion of the pedicle with preservation of adnexal structures.^4-6 In torsion of para ovarian cyst diagnosed early, detorsion of it's pedicle with preservation of fallopian tube and removal of the cyst may be a viable option. Physicians need to maintain a high index of suspicion for this uncommon and often difficult to diagnose cause of abdominal pain.

REFERENCES

1. Yalcin OT, Hassa H, Zeytinoglu S. Isolated torsion of fallopian tube during pregnancy, report of two cases. Eur J Obstet Gynecol Reprod Biol 1997;74:179-82.
2. Ferrera PC, Kass LE, Verdile VP. Torsion of the fallopian tube. Am J Emerg Med 1995;13:312-4.
3. Wheeler JE. Diseases of the fallopian tube. In: Kurman RJ, editor. Blaustein's pathology of the female genital tract. New York: Springer-Verlag; 1987. pp. 409-13.
4. Youssef AF, Fayad MM, Shafeek MA.Torsion of the fallopian tube: A clinico-pathological study. Acta Obstet Gynec Scand 1962;41:292-309.
5. Hibbard LT. Adnexal torsion. Am J Obstet Gynecol 1985;152:456-61.
6. Zweizig S, Perron J, Grubb D, et al.Conservative management of adnexal torsion. Am J Obstet Gynecol 1993;168:1791-5.

Copyright 2003 - Indian Journal of Medical Sciences.