March 11, 2016

• 82 year old, postmenopausal woman presented with complaints of lower abdominal pain and constipation for duration of two weeks.
• On examination she had mild abdominal and forniceal tenderness.
• CT abdomen revealed diverticulosis of colon with right adnexal mass of size 7 × 6 cms with heterogeneous density, inseparable from ovary.
• CA 125: normal.
• Diagnostic and operative laparoscopy was done, which showed pus in the abdominal cavity. Bowel was distended. Right ovarian dermoid cyst of 12 ×10 cm size which had undergone torsion three and a half times was seen. Right oophorectomy was done.
• Post-operative period was uneventful.
• One should bear in mind possibility of multiple pathologies when a patient presents with acute abdomen.
• Since her symptoms were due to two different pathologies, diverticulitis and torsion of dermoid cyst, operative laparoscopy with aspiration of pus and oophorectomy helped alleviate her symptoms due to the infection, inflammation and torsion.
• Laparoscopy offers  a  minimally  invasive  route  in  elderly  patients, affording a  less traumatic  and  smoother  post-operative
• This case is unique due to the rarity in presentation of a twisted dermoid cyst at this age.