Complete adnexal torsion of a large dermoid ovarian cyst with ovarian and tubal preservation in a 17-year-old patient: a case report

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Abstract
Dermoid cyst or mature cystic teratoma is the most common ovarian germ cell tumor. Clinical diagnosis is not easy. The acute abdominal pain associated with ovarian dermoid cysts usually involves adnexal torsion. Preoperative diagnosis of adnexal torsion with dermoid ovarian cyst can be based on pelvic imaging combined with clinical findings. Treatment is surgical and should be applied without delay. Cystectomy is the treatment of choice for the management of dermoid ovarian cysts that have undergone torsion and maintain adequate blood supply. Our case report concerns the emergency surgical intervention of a patient with right adnexal torsion and the presence of a large dermoid cyst. The patient came to the Emergency Department of our hospital with symptoms of an acute abdomen. Ultrasound confirmed the diagnosis of adnexal torsion with the presence of a mature cystic ovarian teratoma, and laparotomy with cystectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis of twisted ovarian dermoid cyst. At this point, we must emphasize the crucial contribution of transabdominal pelvic ultrasound in the management of mature cystic ovarian teratomas accompanied by complete adnexal torsion. Early diagnosis and immediate surgical intervention in young patients who wish to preserve ovarian function in order to achieve future pregnancy are of major importance.

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