Rare co-occurrence of appendicitis, ovarian dermoid cyst with torsion: a case report.

Abstract

Introduction: Simultaneous presentation of acute appendicitis and ovarian torsion is rare and requires urgent surgical intervention due to the high risk of complications, including sepsis and mortality. While adnexal torsion is a known cause of acute abdomen in reproductive-age women, co-presentation with appendicitis is exceptionally uncommon. This case underlines the importance of considering gynecological differentials in women presenting with acute abdominal pain.

Case presentation: A 39-year-old woman presented with right lower abdominal pain, fever, and vomiting. Initially diagnosed with an appendicular lump, she was managed conservatively and discharged after symptomatic improvement. Upon recurrence of symptoms, imaging revealed an ovarian dermoid cyst with torsion. Exploratory laparotomy identified a gangrenous ovary with a twisted cyst and adherent appendix. Histopathology confirmed acute appendicitis and a benign dermoid cyst.

Discussion: Adnexal torsion occurs when the ovary and fallopian tube twist around their ligaments, often caused by ovarian cysts like dermoid cysts. These cysts are common in young women and can lead to acute abdominal pain, requiring urgent surgery to prevent ovarian damage. Diagnosis is challenging, as symptoms mimic other conditions like appendicitis. Imaging such as ultrasonography or computed tomography is used, and treatment involves surgical untwisting or removal of affected tissues. Torsion sometimes affects nearby organs, like an appendix.

Conclusion: This case highlights the rare occurrence of simultaneous appendicitis and ovarian torsion, emphasizing the importance of early diagnosis and surgical intervention.