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Mariani A, Hameury F, Dubois R, Demède D, Gelas T, Mure PY, Gorduza D. Isolated Fallopian Tube Torsion in Children With Hydrosalpinx: Is Conservative Management an Option? Pediatr Emerg Care 2024; 40:582-585. [PMID: 38743405 DOI: 10.1097/pec.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is very rare gynecological emergency in pediatric population. Our objective is to assess treatment options and discuss outcome of a cohort of IFTT with a focus on the association between IFTT and hydrosalpinx (HSX). METHODS A retrospective review was conducted. Pediatric patients with IFTT operated in the same center were included. RESULTS Seventeen girls (aged: 11-16 years) were managed for acute abdominal pain between 2008 and 2018, with intraoperative diagnosis of IFTT. All patients underwent laparoscopic exploration, with laparoscopically fallopian tube detorsion in all patients. Based on the association of IFTT with HSX after fallopian tube detorsion, patients were divided into 2 groups: group 1 (IFTT without HSX; 12 girls) and group 2 (IFTT with HSX; 5 girls). During the same surgery, complementary surgical procedures were done. In group 1: salpingectomies (4), partial salpingectomies (2) and cystectomies (6) were done. In group 2: salpingectomy (1), salpingotomy (1), and cyst ablation (1). The treatment was called conservative when the tube was preserved.Follow-up was uneventful in group 1. In group 2, for all patients with initial fallopian tube preservation, further surgical procedures were necessary (1-4 surgeries/patient), and, finally, another 3 patients required salpingectomy. CONCLUSIONS Conservative treatment with tube preservation of IFTT without HSX appeared to be beneficial compared to those with HSX, with no recurrence of torsion or symptoms during the follow-up. However, the same conservative treatment was not sufficiently effective for IFTT with HSX and required further procedures due to recurrence of torsion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Aurora Mariani
- From the Department of Pediatric Surgery, Centre Hospitalo Universitaire, Angers
| | - Frédéric Hameury
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Rémi Dubois
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Delphine Demède
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Thomas Gelas
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Pierre Yves Mure
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Daniela Gorduza
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
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Meyer J, Steinhoff-Kellner A, Stehr M, Schäfer FM. IFTT in children and adolescents-single-center experience and systematic review of literature. Pediatr Surg Int 2024; 40:143. [PMID: 38816521 DOI: 10.1007/s00383-024-05719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Isolated fallopian tube torsion (IFTT) is defined by rotation of the fallopian tube around itself without involving the ipsilateral ovary. It is a rare cause of acute lower abdominal pain in (adolescent) girls, but is commonly overlooked. Due to its rarity, literature is still scarce. Currently there is no generally accepted management and treatment. METHODS A retrospective analysis of all IFTT cases treated in our institution was performed. In addition, a systematic literature research on pediatric IFTT was carried out on Medline/ PubMed database according to PRISMA principles using predefined search terms and inclusion criteria. Patient characteristics regarding age, clinical symptoms, diagnostic methods, treatment, and follow-up were analyzed. RESULTS Three of our patients and fifty-nine reports totaling one hundred seventy girls were included in the analysis. Mean age was 13.0 years. Left tube was slightly more often affected (52.9%). Abdominal pain was present in 99.4% of cases accompanied with nausea in 57.1%. In only 16.4%, correct preoperative diagnosis was made. Salpingectomy was the most common treatment in 111 (66.9%) cases, 55 (33.1%) patients were treated with detorsion of the tube (organ-sparing management). Girls with symptoms longer than 1 day had a significant higher rate of salpingectomy (95% CI, P = 0.0323). CONCLUSION When IFTT is suspected, emergency laparoscopy should be performed to possibly preserve future reproductive potential. In case of detorsion and reinstated blood supply, organ-preserving management should be performed with simultaneous addressment of concomitant pathology if possible. Sufficient long-term follow-up must be assured to get significant results to introduce guidelines for children and adolescents.
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Affiliation(s)
- Johannes Meyer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Diakoneo, 90419, Nuremberg, Germany.
| | - Alina Steinhoff-Kellner
- Department of Gynecology and Obstetrics, Klinikum Hallerwiese, Diakoneo, 90419, Nuremberg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Diakoneo, 90419, Nuremberg, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Diakoneo, 90419, Nuremberg, Germany
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen (FAU), 91054, Erlangen, Germany
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3
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Jo JY, Cho IA, Shin JK, Lee SA, Choi WJ. Laparoscopic surgery for fallopian tube torsion due to benign tumour in the third trimester of pregnancy: a case report and literature review. J OBSTET GYNAECOL 2022; 42:2566-2572. [PMID: 35929982 DOI: 10.1080/01443615.2022.2107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Isolated fallopian tubal torsion is rare among women of reproductive age, and it is even rarer during pregnancy. Despite its rare incidence, it is important to consider this diagnosis to facilitate prompt and effective intervention. We present the case of a pregnant woman in her third trimester who presented with acute right abdominal pain. A 32-year-old primigravida woman at 29 weeks and four days of gestation visited the emergency department with acute right flank and abdominal pain. Sonography and MRI revealed the presence of a right adnexal cystic mass. Exploratory laparoscopy revealed isolated right tubal torsion and a normal ovary. To avoid torsion recurrence, we performed laparoscopic right salpingectomy. The remainder of her gestation was uneventful. Histopathological examination revealed serous cystadenoma with haemorrhagic infarction. We reviewed the literature for cases of isolated tubal torsion in the past 11 years. Twenty-three case reports were included in this study, and the average time from presentation to surgical intervention was 35.6 hours. In these cases, most of the patients underwent laparotomy and had good pregnancy outcomes. Although the approach may vary depending on the situation, the laparoscopic approach should be preferred to laparotomy in the third trimester of pregnancy.
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Affiliation(s)
- Jae Yoon Jo
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - In Ae Cho
- Department of Obstetrics and Gynecology, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Jeong Kyu Shin
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Soon Ae Lee
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Won Jun Choi
- Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Obstetrics and Gynecology, Gyeongsang National University, College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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Contralateral recurrence of fallopian tube torsion: A case report. Case Rep Womens Health 2021; 30:e00307. [PMID: 33777710 PMCID: PMC7985475 DOI: 10.1016/j.crwh.2021.e00307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022] Open
Abstract
Unilateral lower quadrant pain is a common presenting complaint in the emergency room with a wide differential. It is important to consider fallopian tube torsion in the differential, especially in premenopausal women, as fertility-sparing detorsion, especially in a woman with a previous salpingectomy or other fertility-affecting surgery, is essential. This case report is of a 25-year-old woman with worsening left lower quadrant abdominal pain over 24 h found to have an extraovarian cystic mass. When taking into consideration the patient with a history of contralateral fallopian tube torsion secondary to a paraovarian cyst, now presenting with left lower quadrant abdominal pain and a cystic extraovarian mass, immediate laparoscopic evaluation was warranted. Immediate intervention revealed an isolated fallopian tube torsion and resulted in surgical preservation of fertility. Recurrent paratubal cyst resulting in isolated fallopian tube torsion Immediate fallopian tube detorsion as fertility sparing procedure Gross necrotic appearance of adnexa does not require salpingectomy/oopherectomy.
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Güney C, Coskun A. A Fifteen-Year Analysis of Rare Isolated Fallopian Tube Torsions in Adolescent Children: A Case Series. Diagnostics (Basel) 2019; 9:diagnostics9030110. [PMID: 31487839 PMCID: PMC6787606 DOI: 10.3390/diagnostics9030110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 02/05/2023] Open
Abstract
Isolated tubal torsions presenting to the emergency department are a very rare cause of pediatric acute abdominal pain. Since making the diagnosis early is of importance in terms of affecting tubal damage and fertility, we aimed to evaluate cases of isolated tubal torsions in light of the literature. This study included 10 patients under 18 years of age who presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5 ± 1.43 years (range: 12-17 years). The demographic characteristics, surgical findings and techniques, and concomitant pathology results of these patients were retrospectively evaluated. The reason for presenting to the emergency department for the 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 h in seven patients (70%) and more than 24 h in three patients (30%). Of the patients, nine (90%) had tenderness in the lower abdominal quadrant, five (5%) had defense, and three (30%) had rebound. Nausea, vomiting and leukocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Eight patients (80%) underwent open surgery and two (20%) underwent laparoscopic intervention. Detorsion was performed on five (50%) patients and salpingectomy was performed on five (50%) patients. Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the preservation of fertility.
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Affiliation(s)
- Cengiz Güney
- Cumhuriyet University Medical Faculty, Department of Pediatric Surgery, 58140 Sivas, Turkey.
| | - Abuzer Coskun
- Sivas Numune Hospital, Department of Emergency, 58030 Sivas, Turkey.
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Foster G, Keene J. Isolated fallopian tubal torsion: A challenging ultrasound diagnosis. SONOGRAPHY 2019. [DOI: 10.1002/sono.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Grant Foster
- Medical Imaging; The Women's Hospital; Melbourne Australia
- BMI; Barwon Health; Geelong Australia
| | - Jacqueline Keene
- Medical Imaging; The Women's Hospital; Melbourne Australia
- Specialist Imaging for Women; Melbourne Australia
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Bertozzi M, Magrini E, Riccioni S, Giovenali P, Appignani A. Isolated fallopian tube torsion with hydrosalpinx: Review of a debated management in a pediatric population. J Pediatr Surg 2017; 52:1553-1560. [PMID: 28735977 DOI: 10.1016/j.jpedsurg.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To quantify our experience with and assess the literature on diagnosis and management of isolated fallopian tube torsion (IFTT) with hydrosalpinx (HSX) in children. METHODS A PubMed search was performed on pediatric cases of IFTT with HSX to provide a comprehensive review analyzing details and management of this association, focusing on the problem of fertility preservation. RESULTS In addition to our 3 cases, 17 patients of pediatric IFTT associated with HSX were identified, for a total of 21 cases (median age 12.2 years). Menarchal status was present in 10/13 (76.9%); blood tests were reported in 9/20 (42%) showing leucocytosis in 7/9 (75%). Ultrasonography was performed in all cases except one. Laparoscopy was the surgical approach in 84.6% of the reported cases. The torsion was to the right in 36.8%, and to the left in 63.2% of the cases. In one case the torsion was bilateral and asynchronous. Performed procedures were salpingectomy (52.4%) and partial salpingectomy (14.3%); conservative management was reported in 33.3% of the cases. CONCLUSIONS The literature describes different management techniques. Salpingectomy is the most frequently performed procedure but recently conservative management seems to be increasingly applied. A long-term study is necessary to define the most effective treatment for the preservation of future fertility in pediatric patients. TYPE OF STUDY Treatment study (Retrospective Study): LEVEL IV.
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Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy.
| | - Elisa Magrini
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Sara Riccioni
- Sezione di Radiologia, Dipartimento di Scienze Chirurgiche, Radiologiche ed Odontostomatologiche, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Paolo Giovenali
- S.S. Dipartimentale Citologia ed Istologia Diagnostica, S. Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
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8
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Emergent ultrasound evaluation of the pediatric female pelvis. Pediatr Radiol 2017; 47:1134-1143. [PMID: 28779190 DOI: 10.1007/s00247-017-3843-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/13/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
Ultrasound is the primary imaging modality of the pediatric female pelvis and is often requested to evaluate girls with pelvic or abdominal pain or abnormal bleeding. The US interpretation can help guide the clinician toward medical or surgical management. Here we discuss the normal US anatomy of the female pelvis and illustrate, through case examples, conditions encountered when performing emergent pelvic US for common and uncommon clinical scenarios.
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9
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Pelvic pain in the middle of the night: use of MRI for evaluation of pediatric female pathology in the emergent setting. Emerg Radiol 2017; 24:681-688. [PMID: 28547317 DOI: 10.1007/s10140-017-1520-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 05/18/2017] [Indexed: 01/27/2023]
Abstract
Acute pelvic pain in pediatric female patients is a common cause of emergency room visits. Imaging plays a crucial role in the clinical evaluation of these patients. Pelvic pain in female children can result from various pathologies. Ultrasound is the preferred first line imaging study; however, magnetic resonance imaging (MRI) is a helpful adjunct after hours, as it is available 24/7 in many institutions. Advantages of MRI include superior delineation of anatomy and higher tissue contrast resolution, particularly of the small pelvic structures. Given the lack of ionizing radiation, there is increasing use of MRI in children and adolescents, specifically in an emergent setting. In this pictorial review, we discuss pelvic MRI techniques and illustrate imaging findings of common etiologies of pelvic pain, emphasizing the advantages of MRI as an adjunct imaging modality.
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Sakuragi M, Kido A, Himoto Y, Onishi Y, Togashi K. MRI findings of isolated tubal torsions: case series of 12 patients. Clin Imaging 2017; 41:28-32. [DOI: 10.1016/j.clinimag.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/22/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
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12
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Lo GC, Kadoch MA, Simpson W. Isolated fallopian tube torsion: two case reports of a rare entity. Clin Imaging 2016; 40:1004-8. [PMID: 27311014 DOI: 10.1016/j.clinimag.2016.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
Isolated fallopian tube torsion is a rare entity that is difficult to diagnose, as its clinical presentation is often highly nonspecific. Early diagnosis is important to avoid damage or loss of the fallopian tube or even the ovary, as this diagnosis occurs predominantly in women of child-bearing age. Imaging may be helpful in suggesting this difficult diagnosis, with confirmation of this entity made in the operating room. Treatment can range from detorsing the tube to salpingectomy or even salpingo-oopherectomy. Here, we present two cases of isolated fallopian tube torsion, followed by a discussion of its imaging findings.
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Affiliation(s)
- Grace C Lo
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Pl, Box 1234, New York, NY 10029, USA.
| | - Michael A Kadoch
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Pl, Box 1234, New York, NY 10029, USA.
| | - William Simpson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Pl, Box 1234, New York, NY 10029, USA.
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Cabral MDI, Siqueira LM. Hydrosalpinx in Postmenarchal Nonsexually Active Girls: A Review of 6 Cases in a Children's Hospital. J Pediatr Adolesc Gynecol 2015; 28:e203-7. [PMID: 26117410 DOI: 10.1016/j.jpag.2015.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of the study was to identify the presence of hydrosalpinx in postmenarchal nonsexually active girls in a children's hospital and to review the available literature on hydrosalpinx in this population. CASES In a tertiary care children's hospital, we performed a retrospective review of charts from January 1, 2000 to December 31, 2014 and identified six cases of hydrosalpinx in postmenarchal nonsexually active female adolescents ranging in age from 12 to 19 years old. The diagnosis of hydrosalpinx was made using imaging studies. Four of six patients were symptomatic at presentation, and two patients were diagnosed when seen for unrelated reasons. Five of these six girls had previous abdominopelvic surgery. Four girls were given empiric antibiotic treatment for presumed pelvic inflammatory disease related to hydrosalpinx. Two patients required surgical intervention that resulted in complete resolution of the hydrosalpinx. The oldest patient in the series underwent ultrasound-guided drainage of the pyo- and/or hydrosalpinx with subsequent recurrence with tubal ovarian abscess five months later. SUMMARY AND CONCLUSIONS The presence of hydrosalpinx might be discovered in the workup of pelvic pain in nonsexually active adolescents or on routine follow-up in patients with previous abdominal surgery, some of whom are asymptomatic. The underlying pathophysiology for hydrosalpinx in this population remains unclear. Among our cases, postsurgical adhesions appeared to be the most likely predisposing factor for tubular obstruction. Early detection and prompt diagnosis will allow for appropriate conservative or definitive treatment.
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Affiliation(s)
- Maria Demma I Cabral
- Division of Adolescent Medicine, Department of Pediatric Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, Florida.
| | - Lorena M Siqueira
- Division of Adolescent Medicine, Department of Pediatric Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, Florida
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Abstract
Imaging is crucial in expediting the diagnosis and guiding definitive therapy in children with ovarian torsion. This article reviews the multimodality spectrum of imaging findings in pediatric ovarian torsion, focusing primarily on US appearances. We describe predisposing conditions that can lead to torsion, the pathological basis of the radiologic findings in ovarian torsion, and the common diagnostic pitfalls.
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Affiliation(s)
- Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Mark R Ferguson
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA.
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Kazmi Z, Gupta S. Best practice in management of paediatric and adolescent hydrosalpinges: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 195:40-51. [PMID: 26476798 DOI: 10.1016/j.ejogrb.2015.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/17/2015] [Accepted: 09/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hydrosalpinx is a rare cause of abdominal pain in paediatric patients, though cases are documented in the literature. Its aetiology differs considerably from traditional hydrosalpinx due to ascending sexually transmitted infection. Hydrosalpinx can present mimicking an acute abdomen or can be asymptomatic. Management of paediatric hydrosalpinx varies, but often involves surgical removal of the affected tube. METHODS In June 2015, a literature search using relevant keywords was completed on MEDLINE and EMBASE databases to determine best management of paediatric hydrosalpinx. RESULTS We found 66 cases from 38 articles. Surgical intervention took place in 74% of cases (n=49). The most common surgical intervention was salpingectomy. In 3% of cases (n=2), nonsurgical medical management with hormonal therapy was utilized, with post-operative improvement in symptomology. In 23% of cases (n=15), conservative management was utilized: 2 of these cases torted, 4 cases persisted and 9 cases resolved. CONCLUSION Overall, the results of this review demonstrate that there are comparable outcomes between surgical, medical and conservative management. However, medical and conservative management was not often offered, and more research is needed on the subject.
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Affiliation(s)
- Zainab Kazmi
- University of Manchester School of Medicine, Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom.
| | - Sujata Gupta
- Women's Health Directorate, Royal Preston Hospital, Sharoe Green Lane North, Preston, Lancashire PR2 9HT, United Kingdom
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Romano M, Di Giuseppe J, Serri M, Noviello C, Martino A, Cobellis G, Ciavattini A. A possible association between sports and isolated fallopian tube torsion in children and adolescent females. Gynecol Endocrinol 2015; 31:688-92. [PMID: 26291807 DOI: 10.3109/09513590.2015.1056144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Isolated fallopian tube torsion (IFTT) is a rare occurrence characterized by the rotation of the fallopian tube on its own axis, without twisting the ipsilateral ovary. Pre-operative diagnosis is difficult due to the lack of specific clinical symptoms and radiological signs. The etiology is to date unknown and only some pre-disposing factors have been reported. The history, clinical presentation, laboratory findings and surgical treatment of five patients aged 12-16 with IFTT were evaluated. All patients came to be examined for worsening abdominal pain, nausea or vomiting. 75% of them practiced sports involving sudden changes in body position. They all underwent blood tests, ultrasound and Magnetic Resonance and then laparoscopy for the persistence of acute symptoms. Laparoscopic salpingectomy was performed in three patients. Another two needed a conversion to open salpingectomy due to the presence of pelvic adhesions. During the follow-up period, every girl was fine. The cause of IFTT is undetermined. In this series, a close association between IFTT and sports causing rapid body movements was found. The possibility of IFTT should be considered in the differential diagnosis of acute abdominal pain in children or adolescent females, especially if they practice sports.
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Affiliation(s)
- Mercedes Romano
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | - Jacopo Di Giuseppe
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
| | - Matteo Serri
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
| | - Carmine Noviello
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | - Ascanio Martino
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | | | - Andrea Ciavattini
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
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Narayanan S, Bandarkar A, Bulas DI. Fallopian tube torsion in the pediatric age group: radiologic evaluation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1697-1704. [PMID: 25154955 DOI: 10.7863/ultra.33.9.1697] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Fallopian tube torsion is a rare but important cause of acute pelvic pain in young adolescent girls. It is a surgical emergency treated with either detorsion or salpingectomy. The imaging findings can be nonspecific and challenging. However, an accurate early diagnosis is essential for prompt surgical treatment. Our objective was to review whether imaging findings can be specific enough to suggest the diagnosis of tubal torsion prospectively in the appropriate clinical setting. An Institutional Review Board-approved retrospective review of our imaging database from 2005 to 2012 revealed 10 surgically proven cases of fallopian tube torsion. All cases had sonography performed; 5 cases had additional multidetector computed tomography. All 10 patients (9-17 years) presented with acute pelvic pain. Sonographic findings included dilated tubular structures in 6 of 10 cases: adjacent to a normal ipsilateral ovary in 5 of 6 and adjacent to a benign ovarian teratoma in 1. In 4 cases, no dilated tube was identified; 3 of 4 had a cystic mass separate from the ovaries, and 1 had the imaging appearance of a multicystic ovary. Computed tomographic findings in the 5 cases that underwent multidetector computed tomography included a dilated tubular structure in 3 of 5; 2 of 5 had a cystic adnexal mass identified. Although rare, tubal torsion should be considered in female adolescents with acute pelvic pain. Sonography should be the first imaging choice. When a tubular structure or a midline cystic mass associated with a normal ipsilateral ovary is noted, tubal torsion should be considered in the differential diagnosis.
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Affiliation(s)
- Srikala Narayanan
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC USA
| | - Anjum Bandarkar
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC USA
| | - Dorothy I Bulas
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC USA.
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18
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Sonographic Appearance of Adnexal Torsion, Correlation With Other Imaging Modalities, and Clinical History. Ultrasound Q 2014; 30:49-55. [DOI: 10.1097/ruq.0000000000000049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Aydin R, Bildircin D, Polat AV. Isolated torsion of the fallopian tube with hydrosalpinx mimicking a multiloculated ovarian cyst: whirlpool sign on preoperative sonography and MRI. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:45-48. [PMID: 23505037 DOI: 10.1002/jcu.22030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 11/30/2012] [Indexed: 06/01/2023]
Abstract
Isolated torsion of the fallopian tube is a rare case of lower abdominal pain. Early diagnosis of such cases is crucial because it allows for the possibility of salvage surgery and the prevention of irreversible vascular damage. However, diagnosis is rarely made before surgery due to nonspecific clinical and imaging features. We report a case of isolated tubal torsion with specific imaging findings on preoperative ultrasonography, color Doppler ultrasonography, and magnetic resonance imaging that was misdiagnosed as a multiloculated ovarian cyst at a local hospital.
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Affiliation(s)
- Ramazan Aydin
- Department of Radiology, University of Ondokuz Mayis, Faculty of Medicine, Samsun, Turkey
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Sun LT, Ning CP, Guo XJ, Li XY, Liu W, Tian JW. Role of ultrasound in diagnosing isolated torsion of fallopian tube. J Obstet Gynaecol Res 2013; 40:208-14. [PMID: 24102844 DOI: 10.1111/jog.12158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/16/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Li-tao Sun
- Department of Ultrasound; 2nd Hospital Affiliated to Harbin Medical University; Harbin China
| | - Chun-ping Ning
- Department of Ultrasound; Affiliated Hospital of Qingdao University; Medical College; Qingdao China
| | - Xi-juan Guo
- Department of Ultrasound; 2nd Hospital Affiliated to Harbin Medical University; Harbin China
| | - Xiao-ying Li
- Department of Ultrasound; 2nd Hospital Affiliated to Harbin Medical University; Harbin China
| | - Wei Liu
- Department of Ultrasound; 2nd Hospital Affiliated to Harbin Medical University; Harbin China
| | - Jia-wei Tian
- Department of Ultrasound; 2nd Hospital Affiliated to Harbin Medical University; Harbin China
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21
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La Parra Casado C, Molina Fàbrega R, Forment Navarro M, Cano Gimeno J. Fallopian tube disease on magnetic resonance imaging. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Estudio de las enfermedades de las trompas de Falopio mediante resonancia magnética. RADIOLOGIA 2013; 55:385-97. [DOI: 10.1016/j.rx.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 10/06/2012] [Accepted: 10/14/2012] [Indexed: 10/27/2022]
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23
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Togo A, Izumi SI, Sato S, Nakamura E, Goya K, Suzuki T, Ishimoto H, Mikami M. Isolated Tubal Torsion in Adolescence: Case Report and Review. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2011.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Atsuko Togo
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
| | - Shun-ichirou Izumi
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
| | - Shigeru Sato
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
| | - Eri Nakamura
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
| | - Kenichi Goya
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
| | - Takahiro Suzuki
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
| | - Hitoshi Ishimoto
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University Hachiouji Hospital, School of Medicine, Tokyo, Japan
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Gaied F, Emil S, Lo A, Baird R, Laberge JM. Laparoscopic treatment of isolated salpingeal torsion in children: case series and a 20-year review of the literature. J Laparoendosc Adv Surg Tech A 2012; 22:941-7. [PMID: 23067066 DOI: 10.1089/lap.2011.0530] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Isolated torsion of the Fallopian tube, without ovarian torsion, is a rare cause of lower abdominal pain. We report our experience with 4 recent cases, along with data from a 20-year review of the pediatric literature. SUBJECTS AND METHODS The records of 4 cases encountered during a 3-year period were reviewed. A literature review was completed by searching Medline, Medline in Process, Embase, Current Contents, and BIOSIS from 1990 to 2010. RESULTS All 4 patients were diagnosed on laparoscopy. Laparoscopic salpingectomy was performed in 3 cases and laparoscopic detorsion in 1. All three resected specimens revealed hemorrhage and gangrene of the salpinx, with an associated cyst in one. The pediatric literature review, including our report, revealed 33 case reports and case series with 45 patients. Fifty-six percent of cases represented primary torsion, and 44% were secondary to underlying tubal pathology. Thirty percent of girls were premenarchal. The mean age at presentation and symptom duration were 13.2±2.1 years and 5.8±12.5 days, respectively. Fever and leukocytosis were present in 27% and 63%, respectively. Ultrasound, computed tomography scan, and magnetic resonance imaging showed a sensitivity of 22% (8/36), 14% (1/7), and 40% (2/5), respectively. A correct preoperative diagnosis was considered in only 13%. Eighty-eight percent of cases were treated by salpingectomy, and 12% were treated by tubal detorsion. Long-term outcomes of detorsion were not reported. CONCLUSIONS Isolated salpingeal torsion in girls is rarely diagnosed preoperatively, regardless of imaging technique. Laparoscopy is the intervention of choice for definitive diagnosis and management. Salpingectomy is the most frequent treatment. Detorsion without resection may be considered for selected cases, but the long-term outcomes of this approach are unknown.
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Affiliation(s)
- Fady Gaied
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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25
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Isolated torsion of the fallopian tube: a case report and review of the literature. Eur J Pediatr 2011; 170:1329-32. [PMID: 21590267 DOI: 10.1007/s00431-011-1484-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
Isolated torsion of the fallopian tube is a rare medical emergency, especially in premenarchal girls. We present a 9-year-old girl with right-sided lower abdominal pain. Isolated torsion of the fallopian tube was suspected preoperatively because of the clinical presentation combined with the results of ultrasound and magnetic resonance imaging (MRI). At emergency laparoscopy, the isolated torsion of the fallopian tube could be reduced, and the tube could be salvaged. This case report shows that the use of ultrasonography and MRI or CT is a helpful diagnostic tool to recognize this condition at an early stage. Especially in young girls presenting with abdominal pain, this should be kept in mind, as digital vaginal examination and vaginal ultrasound most often cannot be used in the diagnostic process. In conclusion, because prompt surgical intervention is required to preserve the tube and prevent progression to peritonitis and possible detrimental effects on future fertility, isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain in all female patients regardless of age.
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26
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Boukaidi SA, Delotte J, Steyaert H, Valla JS, Sattonet C, Bouaziz J, Bongain A. Thirteen cases of isolated tubal torsions associated with hydrosalpinx in children and adolescents, proposal for conservative management: retrospective review and literature survey. J Pediatr Surg 2011; 46:1425-31. [PMID: 21763846 DOI: 10.1016/j.jpedsurg.2011.01.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 12/15/2010] [Accepted: 01/23/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE Isolated tubal torsion associated with hydrosalpinx is a rare pathology. Our goal was to analyze the clinical and imaging features and discuss the different treatment options available. METHODS We retrospectively reviewed all the cases of adnexal torsion treated in our department of pediatric surgery over a 10-year period. We searched 2 electronic databases (Medline and Sciencedirect) and targeted reports published during the same period using the key words tubal torsion and hydrosalpinx. RESULTS A total of 13 cases, 6 from our hospital and 7 in the medical literature, were identified and analyzed. In 9 (69%) of 13 cases (n = 9/13), torsion and hydrosalpinx occurred on the left fallopian tube. Salpingectomy was performed in 11 of the patients. The resected tubes showed the persistence of ciliated cells associated with signs of moderate ischemic infarction in 50% (n = 3/6) of the cases. CONCLUSIONS Isolated tubal torsion associated with hydrosalpinx is too often misdiagnosed and treated by salpingectomy regardless of the negative impact on the future reproductive potential of our young patients. As is commonly advocated for ovarian salvage in adnexal torsions, tubal conservation should be favored when possible.
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Affiliation(s)
- Samir Alexandre Boukaidi
- Department of Obstetrics Gynecology Reproduction and Foetal Medecine, CHU de Nice, L'Archet hospital, 151 route Saint-Antoine de Ginestière 06200 Nice, France.
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27
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Panteli C, Pickworth FE, Tsang T. Isolated Fallopian Tube Torsion in Childhood and Adolescence: A Case Report and Literature Review. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christina Panteli
- Department of Pediatric Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Fred E. Pickworth
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Thomas Tsang
- Department of Pediatric Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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28
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Lima M, Libri M, Aquino A, Gobbi D. Bilateral hydrosalpinx with asynchronous tubal torsion: an exceptional finding in a premenarcheal girl. J Pediatr Surg 2011; 46:e27-e29. [PMID: 21496522 DOI: 10.1016/j.jpedsurg.2010.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/13/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
Bilateral hydrosalpinx with asynchronous tubal torsion is an extraordinary event in young girls. This report describes the problems associated with misdiagnosis, therapeutic approach, and the risk of suboptimal treatment of this rare clinical entity in a 13-year-old girl.
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Affiliation(s)
- Mario Lima
- Department of Pediatric Surgery, University of Bologna, 40138 Bologna, Italy
| | - Michele Libri
- Department of Pediatric Surgery, University of Bologna, 40138 Bologna, Italy
| | - Antonio Aquino
- Department of Pediatric Surgery, University of Bologna, 40138 Bologna, Italy
| | - Dalia Gobbi
- Department of Pediatric Surgery, University of Bologna, 40138 Bologna, Italy.
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29
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Servaes S, Victoria T, Lovrenski J, Epelman M. Contemporary Pediatric Gynecologic Imaging. Semin Ultrasound CT MR 2010; 31:116-40. [DOI: 10.1053/j.sult.2010.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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30
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MRI appearance of isolated fallopian tube torsion in an adolescent with a congenital müllerian duct anomaly and ispilateral renal agenesis. Clin Radiol 2010; 65:89-93. [DOI: 10.1016/j.crad.2009.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 09/03/2009] [Accepted: 09/07/2009] [Indexed: 11/19/2022]
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31
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Phillips K, Fino ME, Kump L, Berkeley A. Chronic isolated fallopian tube torsion. Fertil Steril 2009; 92:394.e1-3. [PMID: 19342021 DOI: 10.1016/j.fertnstert.2009.01.152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe a case of chronic isolated fallopian tubal torsion in a woman without identifiable risk factors and discuss the difficulty of diagnosis. DESIGN Case report. SETTING University-based reproductive endocrinology and infertility center. PATIENT(S) Multiparous woman with no risk factors of torsion of the fallopian tube presenting with chronic right lower quadrant pain. INTERVENTION Laparoscopy with subsequent salpingectomy. MAIN OUTCOME MEASURE(S) Resolution of symptoms. Preservation of ovary and future fertility. RESULT(S) Patient's symptoms resolved after salpingectomy. Information regarding future fertility is pending. CONCLUSION(S) Isolated fallopian tube torsion is rare and often difficult to diagnose. Despite ultrasonographic evidence of arterial and/or venous flow to the adnexa, adnexal torsion cannot be ruled out. If clinical suspicion for torsion is high, early diagnosis and treatment via laparoscopy is encouraged as a means of preserving fallopian tube integrity and maintaining fertility, especially in reproductive-age women.
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Affiliation(s)
- Kameelah Phillips
- NYU Fertility Center, Department of Obstetrics and Gynecology, New York University School of Medicine, 660 First Avenue, New York, NY 10016, USA
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32
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Noninflammatory fallopian tube pathology in children. Pediatr Radiol 2008; 38:1330-7. [PMID: 18936935 DOI: 10.1007/s00247-008-1034-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Revised: 09/02/2008] [Accepted: 09/07/2008] [Indexed: 10/21/2022]
Abstract
Noninflammatory tubal abnormalities are rare in children and usually not well covered by traditional educational material. The presenting symptoms are nonspecific and are common to many other conditions, so its preoperative diagnosis is rarely made. The purpose of this study was to review the hospital charts and imaging findings in children and sexually inactive adolescents who showed fallopian tube pathology. Understanding of the pertinent findings of previous imaging examinations might assist radiologists in making the correct preoperative diagnosis and increase the likelihood of preserving the fallopian tubes. The clinical entities described in this article include isolated tubal torsion, paratubal cysts, hydrosalpinx, undescended/ectopic fallopian tube, and tubal inguinal hernia.
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33
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Potter AW, Chandrasekhar CA. US and CT Evaluation of Acute Pelvic Pain of Gynecologic Origin in Nonpregnant Premenopausal Patients. Radiographics 2008; 28:1645-59. [DOI: 10.1148/rg.286085504] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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34
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Markhardt BK, Jones L, Drugas GT. Isolated torsion of the fallopian tube in a menarchal 11-year-old girl. Pediatr Emerg Care 2008; 24:374-6. [PMID: 18562880 DOI: 10.1097/pec.0b013e318177a727] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Isolated torsion of the fallopian tube is a rare cause of an acute lower abdominopelvic pain in adolescent females that is difficult to recognize preoperatively. This is a case report of an 11-year-old girl who presented with a right lower quadrant abdominal pain, nausea, and vomiting secondary to isolated torsion of the right fallopian tube 2 days after the onset of her first menses. In this report, the patient's clinical course is discussed with special emphasis on diagnostic imaging and management strategy of adnexal torsion in pubertal and adolescent girls.
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Affiliation(s)
- Brian Keegan Markhardt
- Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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35
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Harmon JC, Binkovitz LA, Binkovitz LE. Isolated fallopian tube torsion: sonographic and CT features. Pediatr Radiol 2008; 38:175-9. [PMID: 18060398 DOI: 10.1007/s00247-007-0683-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 10/03/2007] [Accepted: 10/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) rarely occurs in pediatric patients and is difficult to diagnose preoperatively. OBJECTIVE To determine the common sonographic and CT findings in girls with IFTT. MATERIALS AND METHODS We retrospectively reviewed the hospital charts and imaging studies of the eight girls diagnosed with and treated for IFTT at Columbus Children's Hospital between January 1995 and June 2006 whose final diagnosis was IFTT. RESULTS The mean age was 13 years with a range of 12 to 15 years. Two girls were premenarcheal. The most common presenting symptom was acute pelvic pain (n = 5). All patients were imaged. Six girls were imaged first with US, and the most common finding was a complex cystic pelvic mass in the midline (n = 5) and normal uterus and ovaries. Three of the eight girls had imaging with CT. In two girls, the torsed tube could be identified. In 63% of the girls, the uterus was deviated toward the side of torsion. The correct preoperative diagnosis was made in only one girl. None of the torsed fallopian tubes was salvaged at surgery. Pathological findings included ipsilateral adnexal cysts associated with the torsed tube (n = 7). CONCLUSION IFTT should be considered in the differential diagnosis for perimenarcheal girls who present with acute pelvic pain and who demonstrate a cystic mass in a midline position (either in the cul-de-sac or superior to the uterus) associated with a normal ipsilateral ovary.
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Affiliation(s)
- Jenna C Harmon
- Department of Radiology, Columbus Children's Hospital, 700 Children's Way, Columbus, OH, 43205, USA
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