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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 2024:00006565-990000000-00464. [PMID: 38743405 DOI: 10.1097/pec.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Zijun L, Yaqin Z, Weiwen P. A rare case of isolated fallopian tubal torsion in adolescent girls: A case report and system review of literature. SAGE Open Med Case Rep 2023; 11:2050313X231215207. [PMID: 38047268 PMCID: PMC10691320 DOI: 10.1177/2050313x231215207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Isolated torsion of a fallopian tube in adolescent girls is a very rare acute abdomen. How to early diagnose and treatment isolated torsion of a fallopian tube has always been one of key points. We reported a rare case of isolated torsion of a fallopian tube in a 14-year-old girl and conducted a systematic review of the literature over the past 21 years. We collected data on clinical characteristics, diagnosis and treatment, prognosis and follow-up outcomes. According to our research strategies, 43 reported cases were included. The results (Mean ± SD) showed that the onset age was 14.09 ± 2.49, the cycle torsion was 2.79 ± 1.18, and the cyst size was 6.43 ± 2.25. The main clinical symptoms (percentage) are 100% lower abdominal pain, 67.44% nausea, 51.16% vomiting, and 50.00% right side lesions. And the accurate rate of preoperative diagnosis was only 27.91%, in which laparoscopic exploration, tubal necrosis, and tubal preservation accounted for 79.07%, 41.86%, and 32.56%, respectively. Extremely difficult diagnosis of isolated torsion of a fallopian tube, because of non-specific clinical manifestations, led to the adverse clinical outcome of salpingectomy. However, the accuracy of preoperative diagnosis can be improved by improving acknowledge of ultrasound diagnosis and the awareness of clinical gynecologists. However, the accuracy of preoperative diagnosis can be improved by improving knowledge of ultrasound diagnosis and awareness of clinical gynecologists. The laparoscopic exploration is sole gold standard for diagnosis and treatment. The operation of preserving the fallopian tube may be the first choice, especially in the early stage of isolated torsion of a fallopian tube.
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Affiliation(s)
- Li Zijun
- Department of Gynecology, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Quzhou, Zhejiang Province, China
| | - Zheng Yaqin
- Longquan Regional Medicine Inspection Center, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Quzhou, Zhejiang Province, China
| | - Pang Weiwen
- Department of Pathology, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Lishui, Zhejiang Province, China
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3
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Awal S, Regmi PR, Prajapati N. Not every twist is ovarian torsion: a case report of isolated torsion of the fallopian tube in a child. Ann Med Surg (Lond) 2023; 85:4142-4144. [PMID: 37554874 PMCID: PMC10406029 DOI: 10.1097/ms9.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Isolated fallopian tube torsion is a rare condition presenting with abdomen pain. The diagnosis is challenging because the clinical findings mimic several other conditions. In this article, we present a case of an adolescent girl who was diagnosed with the condition during laparoscopy. PRESENTATION OF THE CASE A 15-year-old girl presented with complaints of sudden onset left lower quadrant pain, nausea, and vomiting. There was tenderness in the left iliac fossa. Ultrasonography revealed inconclusive findings and contrast-enhanced computed tomography of the abdomen and pelvis suggested possible left adnexal torsion. Hence, she underwent a diagnostic laparoscopy which revealed a twisted, edematous, and congested left fallopian tube. The diagnosis of isolated left fallopian tube torsion was made and she was managed with unilateral salpingectomy. DISCUSSION Women of the reproductive age group are usually affected by this condition. The common presentations are abdominal pain, nausea, and vomiting. The physical examination may reveal abdominal and cervical motion tenderness. Per abdominal ultrasound is the first go-to modality in children. Magnetic resonance imaging, if available, is advised in children if the ultrasound is inconclusive because of the absence of radiation. However, it may require sedation. Therefore, contrast-enhanced computed tomography abdomen gives an added advantage in such scenarios as in our case. This condition is managed by surgery with salpingectomy or tube detorsion with preservation of the tube, depending on the intraoperative findings. CONCLUSION Clinicians should be aware of the condition given the rarity and challenges in the diagnosis of isolated fallopian tube torsion.
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Affiliation(s)
- Shila Awal
- Suryabinayak Municipal Hospital, Bhaktapur
| | - Pradeep Raj Regmi
- Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Wang Y. An isolated left sided fallopian tube with gangrenous necrosis in an adolescent. Arch Gynecol Obstet 2023; 308:639-640. [PMID: 35999404 DOI: 10.1007/s00404-022-06749-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Ying Wang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, China.
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Ali AM, Mohamed AN, Omar AA, Mohamed YG. Laparoscopic management of ischemic right fallopian tube torsion mimicking perforated appendicitis. Int J Surg Case Rep 2022; 93:106914. [PMID: 35298987 PMCID: PMC8927710 DOI: 10.1016/j.ijscr.2022.106914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 10/26/2022] Open
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6
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Moro F, Bolomini G, Sibal M, Vijayaraghavan SB, Venkatesh P, Nardelli F, Pasciuto T, Mascilini F, Pozzati F, Leone FPG, Josefsson H, Epstein E, Guerriero S, Scambia G, Valentin L, Testa AC. Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:934-943. [PMID: 31975482 DOI: 10.1002/uog.21981] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the clinical and ultrasound characteristics of adnexal torsion. METHODS This was a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion, defined as surgical evidence of ovarian pedicle, paraovarian cyst and/or Fallopian tube twisted on its own axis, who had undergone preoperative ultrasound examination by an experienced examiner, between 2008 and 2018. Only cases with at least two available ultrasound images and/or videoclips (one grayscale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrieved from each patient's medical record and entered into an Excel file by the principal investigator at each center. In addition, two authors reviewed all available ultrasound images and videoclips of the twisted adnexa, with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: (1) ovarian stromal edema with or without peripherally displaced antral follicles, (2) the follicular ring sign, (3) the whirlpool sign and (4) absence of vascularization in the twisted organ. RESULTS A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range, 1-88) years. Most patients were premenopausal (284/314; 90.4%) and presented with acute or subacute pelvic pain (305/315; 96.8%). The surgical approach was laparoscopic in 239/312 (76.6%) patients and conservative surgery (untwisting with or without excision of a lesion) was performed in 149/315 (47.3%) cases. According to the original ultrasound reports, the median largest diameter of the twisted organ was 83 (range, 30-349) mm. Free fluid in the pouch of Douglas was detected in 196/275 (71.3%) patients. Ovarian stromal edema with or without peripherally displaced antral follicles was reported in the original ultrasound report in 167/241 (69.3%) patients, the whirlpool sign in 178/226 (78.8%) patients, absent color Doppler signals in the twisted organ in 119/269 (44.2%) patients and the follicular ring sign in 51/134 (38.1%) patients. On retrospective review of images and videoclips, ovarian stromal edema with or without peripherally displaced antral follicles (201/254; 79.1%) and the whirlpool sign (139/153; 90.8%) were the most commonly detected features of adnexal torsion. CONCLUSION Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged adnexa, the whirlpool sign, ovarian stromal edema with or without peripherally displaced antral follicles and free fluid in the pelvis. The follicular ring sign and absence of Doppler signals in the twisted organ are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that the correct treatment, i.e. surgery without delay, can be offered. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Moro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Bolomini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - M Sibal
- Department of Fetal Medicine and Obstetric and Gynecologic Ultrasound, Manipal Hospital, Bangalore, India
| | | | - P Venkatesh
- Department of Fetal Medicine and OBGYN Ultrasound, Manipal Hospital, Bangalore, India
| | - F Nardelli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Institute for Women's Health, University College Hospital, London, UK
| | - T Pasciuto
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - F Mascilini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - F Pozzati
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F P G Leone
- Department of Obstetrics and Gynecology, Biomedical and Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy
| | - H Josefsson
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - G Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - A C Testa
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Kolovos G, Meytap E, Samartzis N, Kalaitzopoulos DR. Isolated torsion of the fallopian tube in a 16-year-old girl: A case report and review of the literature. Case Rep Womens Health 2019; 23:e00132. [PMID: 31316898 PMCID: PMC6611968 DOI: 10.1016/j.crwh.2019.e00132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/24/2022] Open
Abstract
Torsion of the fallopian tube is when the tube twists on the axis created between the infundibulopelvic ligament and the utero-ovarian ligament. It most commonly presents with appendicitis-like symptoms, such as abdominal pain, nausea and vomiting. Because of its rarity and non-specific symptoms, it is usually misdiagnosed initially, which delays therapy, at the expense of the preservation of fertility. This case report of a 16-year-old girl who had never had sexual intercourse presents an example of the misdiagnosis of fallopian tube torsion. The definitive diagnosis was based on laparoscopy. We summarize our experience and provide our conclusions after reviewing the literature.
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Affiliation(s)
- GeorgiosN Kolovos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmy Meytap
- Department of Gynecology and Obstetrics, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Nicolas Samartzis
- Department of Gynecology and Obstetrics, Cantonal Hospital Schaffhausen, Switzerland
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8
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Zaat TR, Braakhekke MWM, Kaaijk EM, Peters LW. Quadruple torsion of the fallopian tube in an 18-year-old virgin: a rare twist. BMJ Case Rep 2018; 2018:bcr-2018-224671. [PMID: 30131412 DOI: 10.1136/bcr-2018-224671] [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: 11/04/2022] Open
Abstract
In this report, we describe an 18-year-old nulliparous virgo, with no medical history, who presented herself at the emergency department with symptoms of lower abdominal pain and nausea with vomiting. On examination, an echogenic unilocular cyst with possible relation to the right ovary was found. The working diagnosis was an ovarian torsion. She underwent a diagnostic laparoscopy which revealed a quadruple torsion of the fallopian tube with hydrosalpinx. Detorsion of the tube was performed, and the tube was drained using diathermic incision. After the surgery, the patient recovered rapidly. Ultrasonic evaluation 38 days later showed an echogenic area measuring 2×3 cm suspected for persistent hydrosalpinx. Because of the asymptomatic postoperative period, the patient was treated conservatively, and no further treatment was performed.
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Affiliation(s)
- Tjitske R Zaat
- Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Eugenie M Kaaijk
- Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Louisette W Peters
- Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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9
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Ssi-Yan-Kai G, Rivain AL, Trichot C, Morcelet MC, Prevot S, Deffieux X, De Laveaucoupet J. What every radiologist should know about adnexal torsion. Emerg Radiol 2017; 25:51-59. [PMID: 28884300 DOI: 10.1007/s10140-017-1549-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/28/2017] [Indexed: 12/29/2022]
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Abstract
Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%-15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.
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Affiliation(s)
- Ci Huang
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Macedo M, Kim B, Khoury R, Narkiewicz L. A rare case of right lower quadrant abdominal pain. Am J Emerg Med 2016; 35:668.e1-668.e2. [PMID: 27842925 DOI: 10.1016/j.ajem.2016.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022] Open
Abstract
Isolated fallopian tube torsion without involvement of the ovary is a rare condition most frequently presenting during reproductive years. Imaging, vitals, physical exam, and laboratory findings all fail to help establish a definitive diagnosis. The majority of the diagnoses are made on the operating table. Physical exam most often reveals unilateral and localized abdominal pain, often with nausea and vomiting, but few other reliably common findings. Diagnosis becomes even more challenging due to the fact that isolated tubal torsion occurs often in pregnancy and preferentially on the right, further complicating the clinical picture. We describe a case of isolated tubal torsion, unique in that localized necrosis and inflammation from the torsion triggered a secondary appendicitis. The patient required surgical intervention, and an appendectomy and salpingectomy emergently. Given its elusive and rare nature, awareness and early intervention is required by the emergency physician to recognize tubal torsion, as operative intervention is crucial, and can lead to preservation of fertility and improved fetal survival.
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Affiliation(s)
- Mark Macedo
- Henry Ford Allegiance Health, Emergency Department, 205 N East Ave, Jackson, MI 48103, United States.
| | - Brian Kim
- Henry Ford Allegiance Health, Emergency Department, 205 N East Ave, Jackson, MI 48103, United States.
| | - Rami Khoury
- Henry Ford Allegiance Health, Emergency Department, 205 N East Ave, Jackson, MI 48103, United States.
| | - Larry Narkiewicz
- Henry Ford Allegiance Health, Department of Surgery, 205 N East Ave, Jackson, MI 48103, United States
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Isolated Torsion of Accessory Fallopian Tube in a Young Adolescent. J Pediatr Adolesc Gynecol 2016; 29:e57-8. [PMID: 26995509 DOI: 10.1016/j.jpag.2016.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/24/2016] [Accepted: 03/04/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Accessory fallopian tube is a rare anatomical variation, which might rarely cause gynecological complications such as infertility, ectopic pregnancy, cystic swelling, and pyosalpinx. It is usually diagnosed by surgeons during diagnostic laparoscopy for other purposes. We present a rare case of isolated accessory tube torsion in a young adolescent. CASE A 16-year-old virgin teen presented with a 24-hour history of aggravating right lower-quadrant abdominal pain and nausea without vomiting or fever. On examination she had right lower quadrant abdominal tenderness with no peritoneal signs. On pelvic ultrasound a right corpus luteum cyst was suspected, but right adnexal torsion could not be ruled out. On laparoscopy, torsion of the right accessory tube was diagnosed. Because of its ischemic and bluish appearance it was removed. The postoperative course was uneventful. Pathology confirmed the diagnosis. SUMMARY AND CONCLUSION Torsion of an accessory fallopian tube is rare. An English literature search showed that the current case is the third reported overall and the first in a young adolescent. Because of the rarity of this congenital variation, and the low suspicion index for its existence, the diagnosis of accessory tube is often missed. Preventive removal of such findings should be considered but weighed against its possible surgical complications.
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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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Toyoshima M, Mori H, Kudo K, Yodogawa Y, Sato K, Kudo T, Igeta S, Makino H, Shima T, Matsuura R, Ishigaki N, Akagi K, Takeyama Y, Iwahashi H, Yoshinaga K. Isolated torsion of the fallopian tube in a menopausal woman and a pre-pubertal girl: two case reports. J Med Case Rep 2015; 9:258. [PMID: 26572791 PMCID: PMC4647800 DOI: 10.1186/s13256-015-0745-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Isolated torsion of the fallopian tube without an ovarian abnormality is an uncommon event, with an incidence of approximately 1 in 1,500,000 females. Isolated torsion of the fallopian tube occurs mostly in reproductive-aged women, and is thus extremely rare in menopausal women and pre-pubertal girls. CASE PRESENTATIONS In case 1, 63-year-old Japanese woman presented with a 2-day history of acute lower abdominal pain. Menopause occurred at 53 years of age. Pelvic ultrasonography showed an enlarged mass (73 × 47 mm) on the right side of her uterus. An urgent laparoscopy was performed based on a presumptive diagnosis of right ovarian tumor torsion. During the laparoscopy, we noted a black, necrotic, solid tumor arising from the distal end of her right fimbria. Her right fallopian tube was twisted with the tumor, but her right ovary was normal and not involved. A laparoscopic tumorectomy with a right salpingectomy was performed. Her post-operative course was uneventful. In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting. Menarche had occurred 2 months earlier. A computed tomography and magnetic resonance imaging examination demonstrated a dilated tubal cystic mass with a normal uterus and bilateral ovaries. An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tube torsion. During laparoscopy, her right fallopian tube was noted to be dark red, dilated, and twisted several times. Her right fimbria was necrotic-appearing and could not be preserved. Therefore, a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, which was consistent with tubal torsion. She had an uncomplicated post-operative course. CONCLUSION We have presented two very rare cases of isolated fallopian tubal torsion. Radiologic interventions, such as computed tomography and magnetic resonance imaging, in addition to ultrasonography, are helpful diagnostic tools. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain with a cystic mass and a normal ipsilateral ovary in all female patients, regardless of age.
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Affiliation(s)
- Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. .,Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Hikaru Mori
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Kei Kudo
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Yuki Yodogawa
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Kazuyo Sato
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Takako Kudo
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Saori Igeta
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Hiromitsu Makino
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Takashi Shima
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Rui Matsuura
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Nobuko Ishigaki
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Kozo Akagi
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Yoichi Takeyama
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Hideki Iwahashi
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. .,Department of Obstetrics and Gynecology, Self-Defense Force Sendai Hospital, Sendai, Japan.
| | - Kosuke Yoshinaga
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
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15
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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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16
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Blitz MJ, Appelbaum H. Torsion of fallopian tube remnant associated with noncommunicating rudimentary horn in adolescent girl with unicornuate uterus. J Pediatr Adolesc Gynecol 2014; 27:e97-9. [PMID: 24332614 DOI: 10.1016/j.jpag.2013.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 06/20/2013] [Accepted: 07/22/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of müllerian anomalies may be as high as 7% in the general population, yet there is scant published literature on adnexal torsion occurring in these patients. CASE A 14-year-old female presented with right lower quadrant pain. Pelvic ultrasonography demonstrated a 2-cm simple right adnexal cyst. Diagnostic laparoscopy revealed a unicornuate uterus with a normal left uterine horn and fallopian tube but atretic and cordlike müllerian structures on the right side. Torsion of the right tubal remnant and two paratubal cysts were noted and the structures were then excised. SUMMARY AND CONCLUSION Agenesis, hypoplasia, or maldevelopment of müllerian structures may predispose patients to an increased risk of adnexal torsion secondary to looser ligamentous attachments and consequent lack of fixation to the pelvic sidewall.
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Affiliation(s)
- Matthew J Blitz
- Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, New York, NY.
| | - Heather Appelbaum
- Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, New York, NY; Division of Pediatric and Adolescent Gynecology, Cohen Children's Medical Center of New York, New York, NY
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17
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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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18
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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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19
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Blitz MJ, Appelbaum H. Management of isolated tubal torsion in a premenarchal adolescent female with prior oophoropexy: a case report and review of the literature. J Pediatr Adolesc Gynecol 2013; 26:e95-7. [PMID: 23602040 DOI: 10.1016/j.jpag.2013.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/03/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Isolated tubal torsion in a premenarchal adolescent girl is a rare phenomenon. Preoperative diagnosis remains a challenge. CASE A 14-year-old premenarchal girl, with a history of bilateral ovarian torsion treated by laparoscopic detorsion and oophoropexy two years prior, presented to the emergency room with lower abdominal pain accompanied by nausea and vomiting. Pelvic ultrasound demonstrated an enlarged left adnexa. Diagnostic laparoscopy revealed an isolated left tubal torsion. Surgical evidence of previous bilateral plication of the utero-ovarian ligaments was confirmed. Untwisting of the left fallopian tube immediately restored the vascular supply. Subsequently, her symptoms resolved. SUMMARY AND CONCLUSION Clinicians should consider torsion of the fallopian tube in the differential diagnosis of lower abdominal pain in all female patients. Prompt laparoscopic intervention is essential. Oophoropexy, while usually efficacious, may not prevent recurrence.
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Affiliation(s)
- Matthew J Blitz
- Department of Obstetrics and Gynecology, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY 11040, USA
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