Abstract
BACKGROUND: Approximately 50% of isolated fallopian tube torsion cases and 5%-10% of tubo-ovarian torsion cases involve an ipsilateral paraovarian cyst. This study aimed to describe the clinical features of paraovarian cyst torsion including isolated fallopian tube torsion and tubo-ovarian torsion and to identify factors associated with delayed surgical intervention. METHODS: In this retrospective cohort study, we included adult women with surgically confirmed adnexal torsion and a coexisting ipsilateral paraovarian cyst at Peking University Third Hospital between January 2012 and December 2024. Group differences were analysed using independent samples t-tests, Mann–Whitney U tests and chi-square or Fisher’s exact tests. Multiple comparisons of clinical features were adjusted using the Benjamini–Hochberg method with a pre-specified false discovery rate threshold of 0.10. Logistic regression was performed to identify factors associated with a surgical decision-making interval exceeding 12 h after emergency department presentation. RESULTS: This study included 142 patients, with 66.2% diagnosed with isolated fallopian tube torsion and 33.8% with tubo-ovarian torsion. The mean diameter of paraovarian cysts was significantly larger in the tubo-ovarian torsion group than in the isolated fallopian tube torsion group (7.4 [5.9, 9.4] vs. 5.3 [4.4, 6.2] cm, q < 0.001). Among patients presenting with acute abdominal pain, the tubo-ovarian torsion group had a higher incidence of identifiable precipitating factors (OR = 3.61, 95%CI: 1.48–8.82, q = 0.040). This group also showed a trend toward a higher incidence of abdominal tenderness (OR = 2.33, 95% CI: 1.01–5.39, q = 0.075) and gastrointestinal symptoms such as nausea and/or vomiting (q = 0.060). However, no significant differences were observed in other pain-related characteristics, including pain severity and radiation patterns. Delayed surgical decision-making (> 12 h) occurred at more than 2.4 times the rate in the isolated fallopian tube torsion group (31.5% vs. 13.0%), though this association was of borderline statistical significance (q = 0.060). Logistic regression identified a paraovarian cyst diameter ≤ 6 cm, along with white blood cell count less than 10 × 10(9)/L, as independent factors associated with surgical decision-making duration exceeding 12 h. CONCLUSIONS: Patients with isolated fallopian tube torsion complicating a paraovarian cyst typically present with smaller cysts and subtler clinical manifestations. Smaller paraovarian cyst diameter and lower white blood cell count were associated with delayed surgical intervention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12905-026-04319-z.