Torsion of an epididymal cyst in a patient of androgen insensitivity: a rare case report

Abstract

Torsion of an epididymal cyst in a patient of androgen insensitivity is an extremely rare presentation. No single case is reported till date which adds to its rarity. We present here such a bizarre and certainly an interesting case report of a 45 years old female patient came with complaints of pain and swelling in left inguinal region since five days. Pain increased in severity in last 3 days without any relief. A single globular tender swelling 6x6 cm size was noted with no cough impulse. With a diagnosis of obstructed hernia the patient was shifted for USG of abdomen which reveals a surprise to all attending surgeons. On USG bilateral cystic swelling were noted with no uterus and cervix. The cystic swelling on left side showed hypoechogenecity. A diagnosis of Mullerian duct agenesis was made with torsion in the left sided cystic swelling. Decision for immediate exploration was taken. On exploration a gangrenous torsion of left epididymal cyst was seen with normal testes. The diagnosis was immediately changed with androgen insensitivity after noting the presence of fully developed testes in this female. Left inguinal orchidectomy was performed in patient with reconstruction of inguinal floor. The post-operative period was uneventful. Patient was discharged on day 7. In the highly advanced robotic age where we exclaim that we know extreme and have explored science to its limits this simple and strange presentation reveals the bizarre and vivid reality of nature. It only cumulates the unseen probabilities of human biology.