Navigating the diagnostic and management challenges of paratubal cysts in adolescents: A case report and primary care insights

Abdominal pain frequently drives patients to seek care at family physician clinics and emergency departments. It often signifies serious underlying conditions, presenting diagnostic challenges for physicians. Failure to diagnose an acute abdomen can result in patient morbidity and mortality and medicolegal risks for physicians. Herein, we report an unusual gynaecological case involving a paratubal cyst in a 15-year-old girl who presented with acute abdominal pain. This case underscores the critical role of primary care physicians in identifying red flags and initiating timely specialist referral. Abdominal ultrasound revealed a large, unilocular mass in the right adnexa, measuring 18x9.8 cm. The patient underwent an emergency laparotomy with a clinical diagnosis of a twisted ovarian cyst. However, intraoperative findings revealed a right paratubal cyst measuring 18x16x16 cm, which was not twisted. A fertility-preserving cystectomy was subsequently performed, successfully removing the cyst while preserving the ovary. Histopathological examination confirmed it as a benign paratubal cyst, consistent with the intraoperative findings. Although paratubal cysts are uncommon, they are a significant cause of abdominal pain. Therefore, timely identification, thorough clinical evaluation and appropriate diagnostic tests are essential for optimal patient care.