Abstract
Introduction:
A 16-year-old girl presented with a 12-hour history of right iliac fossa pain. A 4 cm simple cystic structure was identified on ultrasound, which was posteromedial to the uterus. The differentials were thought to be a duplication cyst or an adnexal mass. Her pain improved and she was discharged with a plan for a repeat ultrasound. However, she re-presented with worsening pain. A pelvic ultrasound was repeated, and the same cystic structure was noted in the right pelvis, distinct from the ovaries and uterus. Differentials suggested by our radiologists included a duplication cyst, dermoid, or meningocele. An MRI was performed, and the most likely diagnosis was felt to be a duplication cyst.
Methods:
A diagnostic laparoscopy was performed, which identified the cyst deep within the right pelvis with the appendix overlying. The cyst was revealed to be a compound volvulus of a paraovarian cyst, with a second discrete volvulus of the adjacent fallopian tube. The volvulus involved at least six 360-degree turns. There was no evidence of viability of the fallopian tube. The right ovary, uterus, left fallopian tube, and ovary appeared healthy. The torted paraovarian cyst and fallopian tube were excised using a Harmonic scalpel and delivered through the umbilicus.
Results:
The girl made a good postoperative recovery and was discharged the following day. Histology revealed transmural infarction of the fallopian tube and paraovarian cyst.
Conclusions:
The risk of torsion of a paraovarian cyst with associated torsion of the adnexa is higher in children. This is a result of the relatively longer infundibulopelvic ligament, which permits migration of the adnexae into the pelvis. Preoperative diagnosis is difficult, and an early diagnostic laparoscopy is indicated to exclude this important differential of right iliac fossa pain. Laparoscopic excision should also be considered with an incidental finding of a paraovarian cyst in a child, to reduce risk to the adnexae.
No competing financial interests exist.
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