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Case report
A 17-year-old nulligravida was admitted under the general surgical team as an emergency with a 2-day history of right iliac fossa pain which had become constant over the 12 hours before admission. The pain radiated to the right leg and was associated with nausea but no vomiting. There were no urinary symptoms and the patient had a regular bowel habit which was unaltered prior to admission. Her menses were regular, the last commencing 16 days before presentation. There was no abnormal bleeding or discharge and the patient was not sexually active. There was no other history of note.
On examination, her temperature was 37.2 degC, her pulse was 97 beats per minute and her blood pressure was 127/68 mmHg. Her abdomen was generally tender with localized guarding and rebound tenderness in the right iliac fossa. Bowels sounds were present and Rovsing's sign was positive. Rectal examination revealed soft stool but no obvious tenderness or mass. Vaginal examination was not performed.
Urine microscopy revealed 20 white blood cells per cubic millimetre but no red blood cells or organisms. Haemoglobin was 14.7 g/dl and the white cell count was 9.1 x 10^sup 9^/l. A clinical diagnosis of acute appendicitis was made and the patient was taken to theatre for appendicectomy.
At operation, the appendix was clinically `mildly inflamed' and an uncomplicated appendicectomy was performed. At routine check of the pelvic organs before closing the abdomen, a mass was found arising from the pelvis and therefore gynaecological assistance was urgently summoned. The incision was extended and the pelvic organs inspected in detail. This revealed a 12 X 12 x 8 cm mass arising from the distal portion of the right fallopian tube comprising solid and cystic components. The mass was completely separate from the ovary, other pelvic organs and the bowel and was attached solely to the proximal portion of the right fallopian tube. There was no evidence of torsion at the time of surgery but a moderate amount of bloodstained fluid was noted within the Pouch of Douglas. Both ovaries, the left fallopian tube,...