Fallopian Tube Torsion Secondary to Paraovarian Fimbrial Cyst: A Difficult to Diagnose and a Rare Cause of Acute Abdomen in Adolescent.

Fallopian tube torsion secondary to paraovarian or paratubal cyst is a rare gynecological cause of acute abdomen. The condition has no distinctive signs and symptoms. There are no characteristic features on radiological imaging, making preoperative diagnosis very difficult. Paraovarian cysts that are less than 4 cm in size are mostly asymptomatic and found incidentally during a pelvic examination or radiological imaging. It seldom leads to any complications like fallopian tube torsion hemorrhage or rupture. We report a case of an adolescent girl, who presented with severe abdominal pain. Transabdominal ultrasound was suggestive of a cystic structure less than 4 cm in size in the left adnexa. Doppler ultrasound showed normal blood flow to both ovaries. Diagnostic laparoscopy was performed, which revealed a twisted left-sided fallopian tube with a fimbrial paraovarian cyst. Detorsion and paraovarian cystectomy was performed. Although paraovarian cysts are mostly asymptomatic, those arising near the fimbrial end can lead to torsion of the fallopian tube, therefore it should always be considered a possible cause of acute abdomen in adolescent girls with adnexal cysts on ultrasound. Timely surgical intervention can prevent complications such as fallopian tube necrosis, gangrene, removal of the tube, and its long-term implications especially in women of the reproductive age group.