Isolated torsion of the fallopian tube in not yet sexually active women and in the early beginning of sexual activity is a rare incidence and most likely due to cysts of the ovary or tubes (1–5). The cysts are mostly observed incidentally but may be the cause of lower abdominal pain in young females, especially when the cysts reach 5 cm or torsion occurs. In most cases the paraovarian/tubal cysts are classified as paramesonephric or mesothelian and less frequently as mesonephric. Operative procedures include resection of the tube or detwisting and fixation of the tube if the tubal tissue remains viable, although the operation is often delayed, and the adnexae can rarely be saved. If paratubal paramesonephric cysts are disclosed occasionally, they should be removed as they may grow and subsequently torsion may occur. Some recommend that bilateral oophoropexy should be considered after the first torsion due to the observation of subsequent asynchronous torsion of the normal opposite adnexae in children (4,5). This report illustrates the isolated torsion of both fallopian tubes with paramesonephric cysts in a 14-year-old virgin and a 17-year-old sexually active woman. A 14-year-old virgin, previously healthy, with menarche at age 12, was admitted to our clinic due to lower abdominal pain for 5 months with growing frequency and intensity accompanied by nausea and vomiting. On physical examination the patient was unaffected but had direct left lower quadrant tenderness. A vaginal ultrasonographic examination disclosed two cystic tumors, of size 5.5 × 7.0 cm and 5.5 × 9.0 cm, respectively (Fig. 1). The tumors were single chambered, with no evidence of solid masses, and located behind a normal uterus. No ascites was observed. Laparascopy showed that both tubes were twisted twice and slightly discolored, but without necrosis. On both sides the tubes were distended by the cystic processes, and laterally the fimbria of the tubes were adherent to the cysts. The ovaries as well as the uterus was of normal size and structure and no other intraabdominal abnormalities were observed. A bilateral salpingectomy was performed and the patient was discharged from our department the following day. Vaginal ultrasonographic examination showed two cystic tumors behind the uterus. The pathologic examination revealed two fallopian tubes, both hyperemic, normally structured and without inflammation. Bilaterally but microscopically clearly separated from the fallopian tube, a cystic structure with a diameter of 4.5 cm was identified. The cysts were smooth-walled and contained serous fluid. The cysts were lined by epithelium containing numerous ciliated cells. The wall of the cysts was hyperemic, built of connective tissue and without muscle cells. The cysts were histologically recognized as paramesonephric cysts. A 17-year-old sexually active woman using hormonal contraception was admitted to our hospital because of progressing abdominal pain in the left fossa. For a couple of months she had suffered from abdominal pain after intercourse, suddenly turning into colic pain accompanied by vomiting. On physical examination the patient had direct tenderness of the lower abdomen especially on the left side. The vaginal ultrasonic examination showed a cystic process of 4.5 cm connected to the left adnexa. Laparoscopy disclosed a cyanotic left tube twisted four times and in close proximity to a 4.0 × 5.0 cm large cystic process. Both ovaries were normal and no other abnormalities were found. A left salpingectomy was performed and the patient was discharged the next day. The pathologic examination showed a hyperemic, normally structured fallopian tube. Adherent to the fallopian tube a cystic process of 4.0 × 5.0 cm was identified. The cyst was smooth-walled and contained serous fluid. The cyst was located in the mesosalpinx and the lumen of the cyst was lined by a tuba-like epithelium. The 1-mm-thick wall of the cyst was fibrotic, hyperemic and without inflammation, and was histologically recognized as a paramesonephric cyst. Torsion of the fallopian tubes in childhood and early puberty is rare (3), and synchronous bilateral torsion as seen in one of our patients occurs very infrequently, although observations of subsequent asynchronous torsion have been described (4). However, as observed in our patients, torsion of the tubes should be included in the differential diagnosis in young women with acute abdominal pain. Nausea and vomiting are associated with the onset of pain, whereas in appendicitis these symptoms do not occur immediately. Prompt diagnosis and surgical intervention are essential for salvaging the tubes and eventually the ovaries. Tissue with signs of necrosis should be removed, because detwisting the tube may cause thrombosis (2,5). Embryologically the paramesonephric (Müllerian) ducti fuse to form the uterovaginal canal, and can accidentally form accessory lumina in the fallopian tube. After the onset of puberty dilatation is caused by secretory activity and the risk of torsion is increased. Histologically the cysts from our patients were classified as paramesonephric cysts, which are characterized by a lining of single-layered cuboidal or columnar epithelium, with microvillous and ciliated cells and mucous secretion, and without musculature in the wall of the cyst. This type of embryologic cyst is the most frequent.