Torsion of a Paraovarian Cyst Mimicking Acute Appendicitis in an Adult Unmarried Woman: A Rare Diagnostic and Surgical Challenge

Abstract

Paraovarian cysts are generally benign adnexal lesions and are frequently asymptomatic. Although uncommon, torsion of a paraovarian cyst may produce an acute abdomen and closely mimic common surgical emergencies such as acute appendicitis. Early recognition is important to prevent irreversible adnexal ischemia and preserve ovarian function. A 21-year-old woman presented with sudden-onset right lower abdominal pain of approximately one-day duration. Clinical examination revealed right iliac fossa tenderness with guarding, rigidity, and rebound tenderness, initially raising suspicion of acute appendicitis. Ultrasonography demonstrated a 5.9 × 6.5 × 5.9 cm right adnexal cystic lesion without obvious solid component, calcification or septation. Color Doppler demonstrated preserved arterial flow but absent venous flow. The appendix measured approximately 6.5 mm without significant periappendiceal inflammatory changes. In view of the clinical and radiological suspicion of adnexal torsion, emergency diagnostic laparoscopy was performed. Intraoperatively, torsion involving the right ovary, fallopian tube, and paraovarian cyst with twisting of the vascular pedicle was identified. The adnexa was successfully detorsed, with preservation of ovarian viability, followed by right paraovarian cystectomy. The cyst contained clear fluid. Histopathological examination demonstrated a benign cystic lesion serous type. The postoperative course was uneventful. This case highlights the diagnostic difficulty of paraovarian cyst torsion presenting as acute right iliac fossa pain and mimicking appendicitis. Preserved arterial flow does not exclude adnexal torsion, and early laparoscopy facilitates definitive diagnosis, ovarian preservation, and treatment.