Paratubal endosalpingiosis: A case report
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A 14-year-old female, presented to the emergency room with complaints of abdominal pain. The pain suddenly started about 8 hours before admission, with higher intensity in the right lower quadrant of the abdomen that was slightly relieved by flexing the right hip. It was a non-colic constant pain with no relation to eating. She had no such pain before and the history of medication intake and previous diseases was unremarkable. An accurate investigation of the accompanying symptoms provided us with loss of appetite, nausea and vomiting containing food particles, without having or detecting fever. The defecation was normal. She had no complaints of urinary tract symptoms and the last menstruation was two weeks before (the patient’s irregular periods were also noticed but she didn’t have heavy bleeding).

On examination, the patient was alert and her vital signs were normal with no sign of icterus, paleness or cyanosis but a brief dehydration was revealed in the mucosa of the patient. Abdominal obesity was present. The abdomen was without distention, without any surgical scarring or muscle guarding. In palpation, a rebound tenderness was observed in the right lower quadrant of the abdomen.

Lab test revealed WBC of 15600/ml, PMN of 82 %, Beta HCG Negative, and CRP of 56. Urine analysis was reported normal as well. A blind loop which was a peristaltic, non-comprehensible, 7 mm in diameter, and strongly in favor of appendicitis was reported in abdominal sonography.

After fluid therapy and starting antibiotics, the patient was sent to the operating room with the initial diagnosis of acute abdomen. The abdomen was opened in the operating room with a McBurney incision. Upon entry into the abdomen, a little bloody discharge was noted. There were no purulent and biliary discharges. Food and feces residues were not detected. The appendix, cecum, and 100 cm distal to the terminal ileum were normal. The ovary was also normal. In examining the fallopian tube, torsion of a para tubal cyst was evident and it was decided to release the bundle leading to torsion first. It was a single 2 cm cyst that became deteriorated

. As the gangrene was complete, resection was performed and the section was handed over to the pathology laboratory for histological investigation of the specimen. The patient was kept under observation for 1 day. Finally, by the time interventions seemed to resolve the situation, with the patient having stable vital signs. After good tolerance of a normal diet and in a good general condition the patient was discharged, with prescriptions for analgesics and antibiotics and proper information about warning signs of possible further complications. Follow up showed no complications. Endosalpingiosis was reported in the pathological examination.