torsion of uterine adnexa is an important cause of acute abdominal pain reported in the literature.1 however , isolated torsion of fimbrial cysts has rarely been described as a cause for acute abdomen.23 we report a rare case of isolated torsion of fimbrial cysts leading to acute abdomen .
a 22-yr - old female presented to the hospital with acute abdomen , amenorrhea for a half month and a half , and spotting on and off .
the patient provided written consent to reproduce information or photographs . on physical examination , the patient s vital signs were found to be normal .
laboratory investigations including hemoglobin , total leucocyte count , differential leucocyte count , and routine and microscopic examination of the urine were found to be normal .
therefore , a serum beta human chorionic gonadotropin ( hcg ) test was done to confirm pregnancy . however , serum beta hcg levels were within normal range .
the ultrasound report showed a tubo - ovarian mass in the right adnexa along with fluid in the pouch of douglas , suggestive of fimbrial cysts or ectopic pregnancy ( fig .
on laprotomy , multiple cystic structures attached to the fimbriae were seen , which were twisted at their pedicle .
many of them had ruptured leading to collection of about 200 ml of straw colored fluid .
however , the fallopian tubes and ovaries were normal on both the sides , so a cystectomy was done .
multiple cystic structures varying in size from 3  3 cm to 2  2 cm were seen .
the cystic structures were filled with yellow colored fluid and were twisted at the pedicle ( fig .
2 ) . histopathology showed ciliated , columnar cells with underlying stroma and few chronic inflammatory cells , and a diagnosis of fimbrial cysts was made ( fig .
paraovarian cysts represent approximately 10% of adnexal masses.4 they are more common in childbearing women.5 paratubal cysts arise from mllerian or wolffian structures and are common in adult females .
these are hormone sensitive and are generally asymptomatic.6 malignant neoplasms arising from paratubal cysts are very rare.7 rarely , they can be associated with torsion of fallopian tubes.7 other complications include hemorrhage , rupture , and infection.3 paratubal cysts are difficult to diagnose preoperatively , and even transvaginal ultrasound in older women has detected only about 44% of paratubal cysts
preoperatively.8 in only 1 of 15 patients is the diagnosis of fimbrial cyst suspected before surgery.4 thus , acute abodomen is a rare presentation of fimbrial cysts , which needs to be considered in a female of reproductive age group .
timely diagnosis and excision of these cysts may prevent the rare complications of torsion and rupture that are associated with them .
 we present a case of a 22-year - old female who presented with acute abdomen and amenorrhea . 
 emergency laprotomy was done with a clinical diagnosis of ectopic pregnancy . 
 on laprotomy , twisted fimbrial cysts were found . 
 thus , although fimbrial cysts are rarely twisted , they should be considered as a cause of acute abdomen in a female of reproductive age group . 
Introduction
Case Report
Discussion