Jelassi Adel, BelhadjAli Ali, Omry Ahmed, Ferjaoui Wael, Haloui Nabil, Khalifa Med Bachir
General Surgery Department, Military Hospital of Gabes, Bab Bhar 6000, Gabes, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
Int J Surg Case Rep. 2025 Jan;126:110726. doi: 10.1016/j.ijscr.2024.110726. Epub 2024 Dec 9.
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.
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.
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.
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.
输卵管旁囊肿是常见的附件病变，可导致诸如扭转等并发症，尤其是在孕期，由于其症状与急性外科急症重叠，给诊断带来挑战。本研究通过病例报告和文献综述详细阐述了输卵管旁囊肿扭转的临床特征及处理方法。
一名孕28周的29岁孕妇出现右下腹疼痛和恶心症状。初步检查显示白细胞增多和C反应蛋白升高。腹部超声未发现阑尾炎或附件包块的明确证据，初步诊断为阑尾炎。行剖腹探查术，发现一个扭转坏死的输卵管旁囊肿。进行了囊肿切除术，阑尾外观正常。患者术后恢复顺利，术后第三天出院。
输卵管旁囊肿扭转较为罕见，每10000次妊娠发生率为3至5例，常被误诊为其他疾病。影像学技术的诊断价值有限。手术干预仍然是确定性治疗方法，孕早期首选腹腔镜手术，但孕晚期往往需要剖腹手术。
本病例强调了孕28周时输卵管旁囊肿扭转的罕见性及其带来的诊断挑战。及时的手术干预对于保留生殖潜能至关重要。提高医疗服务提供者的认识对于提高诊断准确性和改善治疗结果至关重要。
