cysts related to the mullerian system usually occur in paraovarian ( 1 ) or paratubal regions ( 2 ) .
an eleven year old girl presented to the emergency department with a twenty four history of abdominal pain , fever and nausea .
on presentation she was clinically dehydrated , pyrexial , and the lower abdomen was full with tenderness in the right iliac fossa and hypogastrium .
inflammatory markers showed elevated c - reactive protein of 331 mg / ml ( normal < 10 mg / ml ) and a total white cell count of 29.7 x 10/l ( range 5- 13.0 ) with a neutrophilia of 27.0 x 10/l ( range : 1.5- 8.0 ) .
( fig 1&2 ) ultrasound image of longitudinal view of multicystic pelvic mass ultrasound image of coronal view of multicystic mass following resuscitation she underwent laparotomy
on gram stain only a few white blood cells were seen and fluid culture did not identify an organism .
the histopathological analysis revealed both cysts to be lined focally by ciliated and non - ciliated epithelium forming plicae .
however , for the major part , the cysts were lined by acute inflammatory exudate .
in the paratubal and paraovarian regions the majority of the cysts are of mullerian origin and can account for up to 76% of all the cysts ( 3 ) .
they are more common in adults and only occur rarely in adolescents ( 4% ) ( 3 ) .
dilatation of these cysts could be anticipated after menarche , due to the secretory activity of the lining epithelium under the influence of the hormones ( 3 ) .
large cysts could cause symptoms such as nausea , pain and vomiting ( 4 ) .
some undergo torsion ( 5,6 ) with severe pain and other may also cause torsion of the fallopian tubes ( 2 ) . in large adult series pelvic pain and
a neoplastic potential has been identified ( 6,7 ) with the incidence varying from 1.69% to 2 % .
no case of inflamed paratubal cysts appears in the english literature . we can only postulate that contributory factors in our case could have included low grade infection due to previous meningitis and vp shunts .
it shows a wide range of findings ( 8) , but the majority are simple cysts .
multilocular cysts , as in our case are very rare accounting for only 4% of the cases ( 8) .
occasionally a normal ovary abutting a cyst gives a clue to the origin of these cysts but accurate pre op diagnosis remains rare .
mri may give more detailed three dimensional information but essentially features are the same as an ultrasound .
kishimota et al suggested that most paraovarian cysts were homogenous , near the ipsilateral round ligament and uterus ( 9 ) .
laparoscopy has been used successfully in paediatric practice to deal with large or complicated paraovarian cysts ( 4 ) .
the indication for open surgery is malignancy or suspicion of malignancy , dense adhesions or large cysts ( 6 ) , as was the case in our patient . in our patient laparoscopic surgery would have been impossible due to the obliteration of the peritoneal cavity . in summary
we report a very rare case of bilateral inflamed fimbrial cysts which were identified and excised during laparotomy for an acute abdomen .
 paramesonephric duct remnants are an infrequent cause of abdominal symptoms in childhood . 
 preoperative diagnosis is often difficult and diagnosis is usually made at surgery . 
 we report a rare presentation of an acute abdomen in a child with bilateral inflamed fimbrial cysts . 
 ultrasound revealed the presence of a multicystic lesion behind bladder . 
 it was only at laparotomy the diagnosis of bilateral inflamed fimbrial cysts was establsihed . 
 these were excised and the child made an uneventful post operative recovery . 
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