Cystic Surprise – A Rare Case of Paraovarian Cyst in Post Hysterectomized Women Adherent to Anterior Abdominal Wall

Background:Para ovarian cysts (POCs) consist of 10% of adnexal masses approximately 1. These are more prevalent among women in 30-40 years of age. A simple cyst can suffer multiple transformations, resulting in a neoplastic paraovarian cyst, that is usually benign, or in a serous cyst similar to benign ovarian tumour. It can be challenging to distinguish between ovarian cyst and Para ovarian cyst using imaging, these cysts are frequently found intraoperatively during laparotomy. Whereas, diagnosing adnexal masses or neoplasms with magnetic resonance imaging (MRI) has proven beneficial. Increased knowledge of the MRI features associated with POCs could result in MRI playing a significant role in avoiding surgery by offering a non-invasive diagnosis. Hence, this report highlights a rare case of Para ovarian cyst in post hysterectomized women along with its diagnostic procedures and management Case Report:A 38 years old female presented to emergency unit with complaints of pain in lower abdomen since 6-8months. She was hysterectomized 2 years back The obstetric history consisted of two live births, and tubal ligation. CECT Abdomen and pelvis - large septated cystic mass of size 8 *7 cms in right adnexal region extending to right iliac fossa – Right ovarian complex mass. Omental adhesions were present. Laparoscopy revealed a large paraovarian cyst of ~ 8m * 7 cm in size which was twisted around infundibulopelvic ligament on Right side. Right fallopian tube was oedematous and overstretched over it. Right ovary was bulky which was adhered to anterior abdominal wall with adhesions. Conclusion: Paraovarian cysts should be kept in mind as a differential diagnosis for patients with adnexal masses both by gynaecologists and radiologists. The importance of differentiating paraovarian cyst from ovarian cyst cannot be overemphasized. The role of expectant management in paraovarian cyst needs to be studied. Laparoscopic approach is feasible in all cases.