A rare case report: Management of paratubal cyst torsion in the second trimester and literature review

Introduction and importance: Paratubal cysts are common adnexal lesions that can lead to complications such as torsion, especially during pregnancy, presenting diagnostic challenges due to symptom overlap with acute surgical emergencies. This study details the clinical characteristics and management of paratubal cyst torsion through a case report and literature review.

Case presentation: A 29-year-old pregnant woman at 28 weeks gestation presented with right iliac fossa pain and nausea. Initial investigations revealed leukocytosis and elevated C-reactive protein. An abdominal ultrasound showed no clear evidence of appendicitis or adnexal masses, leading to a presumptive diagnosis of appendicitis. Laparotomy was performed, revealing a twisted, necrotic paratubal cyst. A cystectomy was conducted, with the appendix appearing normal. The patient had an uneventful postoperative course and was discharged on postoperative day three.

Discussion: Paratubal cyst torsion is rare, with an incidence of 3 to 5 per 10,000 pregnancies, often misdiagnosed as other conditions. Imaging techniques have limited diagnostic value. Surgical intervention remains the definitive treatment, with laparoscopic methods preferred in early pregnancy, though laparotomy is often necessary in later stages.

Conclusion: This case emphasizes the rarity of paratubal cyst torsion at 28 weeks of gestation and the diagnostic challenges it presents. Timely surgical intervention is crucial for preserving reproductive potential. Increased awareness among healthcare providers is essential for improving diagnostic accuracy and outcomes.