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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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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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Ramadan MK, Demachkie K, Mohsen A, Sinno L, Kaza'al J. Isolated Tubal Torsion: A Rare Cause of Acute Pelvic/Abdominal Pain among Adolescent Females. Gynecol Minim Invasive Ther 2020; 9:241-244. [PMID: 33312871 PMCID: PMC7713664 DOI: 10.4103/gmit.gmit_91_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/30/2019] [Accepted: 03/11/2020] [Indexed: 11/14/2022] Open
Abstract
Tubal torsion usually occurs as a part of adnexal torsion that affects an ovary and the adjacent tube; however, isolated tubal torsion is an extremely rare condition. Usually, it presents as acute pelvic/abdominal pain but could also exhibit milder intermittent pain alternating with periods of relief (subacute). This condition has seldom been diagnosed preoperative and commonly results in tubal damage due to delayed management. We hereby, report the findings of two cases managed recently at our center. In both cases, the diagnosis was delayed 2–3 days and was only made intraoperative when the tubes could not be salvaged due to extensive necrosis. The extent of tubal damage is predominantly dependent on the duration of vascular insult; hence, the urgency for affecting early diagnosis and intervention to restore blood supply and preserve tubal integrity and function. We advocate the liberal and early use of laparoscopy in patients presenting with subacute unexplained pelvic/abdominal pain.
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Affiliation(s)
- Mohamad K Ramadan
- Department of Obstetrics and Gynecology, Rafik Hariri University Hospital, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
| | - Khouloud Demachkie
- Department of Obstetrics and Gynecology, Rafik Hariri University Hospital, Beirut, Lebanon.,Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Amani Mohsen
- Department of Obstetrics and Gynecology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Loubna Sinno
- Research Unit, Makassed General Hospital, Beirut, Lebanon
| | - Janoub Kaza'al
- Department of Obstetrics and Gynecology, Rafik Hariri University Hospital, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Lebanese University, Beirut, Lebanon
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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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Isolated fallopian tube torsion in adolescents. Case Rep Obstet Gynecol 2013; 2013:341507. [PMID: 24251052 PMCID: PMC3819798 DOI: 10.1155/2013/341507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/06/2013] [Indexed: 12/04/2022] Open
Abstract
Background. Fallopian tube torsion is a rare cause of acute abdomen, occurring commonly in females of reproductive age. It lacks pathognomonic symptoms, signs, or imaging features, thus causing delay in surgical intervention. Case. We report two cases of isolated fallopian tube torsion in adolescent girls. In the first case a 19-year-old patient presented with acute pain in the left iliac region associated with episodes of vomiting for one day and mild tenderness on examination. Laparoscopy revealed left sided twisted fallopian tube associated with hemorrhagic cyst of ovary. The tube was untwisted and salvaged. In another case an 18-year-old virgin girl presented with similar complaints since one week, associated with mild tenderness in the lower abdomen and tender cystic mass on per rectal examination. On laparoscopy right twisted fallopian tube associated with a paratubal cyst was found. Salpingectomy was done as the tube was gangrenous. Conclusion. Fallopian tube torsion, though rare, should be considered in women of reproductive age with unilateral pelvic pain. Early diagnostic laparoscopy is important for an accurate diagnosis and could salvage the tube.
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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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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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9
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Bayirli R, Oge T, Uysal E, Hassa H. Isolated torsion of the fallopian tube in a 16-year-old adolescent girl. J OBSTET GYNAECOL 2011; 31:349-50. [PMID: 21534766 DOI: 10.3109/01443615.2011.556272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R Bayirli
- Department of Obstetrics and Gynecology, Ozel Eskisehir Sakarya Hastanesi, University School of Medicine, Eskisehir, Turkey
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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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Affiliation(s)
- Shalini Rajaram
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital & University College of Medical Sciences, Delhi, India
| | - Shaili Nigam
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital & University College of Medical Sciences, Delhi, India
| | - Neerja Goel
- Department of Obstetrics and Gynaecology, Guru Teg Bahadur Hospital & University College of Medical Sciences, Delhi, India
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Laparoscopic management of isolated fallopian tube torsion in a premenarchal 13-year-old adolescent girl. Arch Gynecol Obstet 2008; 279:909-10. [PMID: 18936948 DOI: 10.1007/s00404-008-0809-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
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