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Chen J, Li C, Zhang H, Li D, Wang W. Tubal mesosalpinx cysts combined with adnexal torsion in adolescents: a report of two cases and review of the literature. BMC Pediatr 2024; 24:525. [PMID: 39143528 PMCID: PMC11323605 DOI: 10.1186/s12887-024-05001-9] [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] [Received: 05/07/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Tubal mesosalpinx cysts are paratubal cysts, that account for approximately 10% of adnexal masses, and the presence of these cysts combined with adnexal torsion is a rare acute abdominal condition, with few cases reported in the literature. We reported two cases of adolescent tubal mesosalpinx cysts combined with adnexal torsion and reviewed the literature to help improve the diagnosis of the disease. CASE REPORTS The first patient was an 11-year-old girl with left lower abdominal pain for 5 days and fever with nausea and vomiting for 3 days, who was found to have a cystic pelvic mass on preoperative imaging and was diagnosed intraoperatively and postoperatively on pathology as having a left tubal mesosalpinx cyst combined with adnexal torsion. The second patient was a 13-year-old girl with right lower abdominal pain for 16 h and a palpable mass in the lower and middle abdomen on examination, which was hard and tender to palpate. Preoperative imaging revealed a large cystic mass in the right adnexal region, and intraoperative and postoperative pathology revealed a right tubal mesosalpinx cyst combined with adnexal torsion. CONCLUSIONS Tubal mesosalpinx cysts combined with adnexal torsion are rare causes of acute lower abdominal pain. Early diagnosis and timely surgery are necessary to ensure ovarian and tubal function. Accurate preoperative imaging diagnosis is challenging, and MRI is a beneficial supplement to ultrasound and CT examinations, providing more objective imaging information and reducing the incidence of adverse outcomes.
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Affiliation(s)
- Junzhuo Chen
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmen Street, Fengtai District, Beijing, 100069, China
| | - Changjun Li
- Department of Radiology, Linzhou People's Hospital, Linzhou, China
| | - He Zhang
- Department of Gynecology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Dongqi Li
- Department of Radiology, Linzhou People's Hospital, Linzhou, China
| | - Wei Wang
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmen Street, Fengtai District, Beijing, 100069, China.
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Schwartz B, Weerasooriya N, Mercier R, Gould S, Saul D, Berman L. Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients. J Pediatr Surg 2024; 59:1538-1544. [PMID: 38649311 DOI: 10.1016/j.jpedsurg.2024.03.054] [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] [Received: 06/02/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population. METHODS We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient. RESULTS Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%. CONCLUSIONS IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- Beth Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
| | - Nimali Weerasooriya
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon Gould
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - David Saul
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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Yazawa R, Yazawa H, Anjyo K, Inazuki A. Four cases of isolated fallopian tube torsion successfully treated with laparoscopic surgery:A case series. Fukushima J Med Sci 2024; 70:163-168. [PMID: 38925957 PMCID: PMC11330265 DOI: 10.5387/fms.23-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/19/2024] [Indexed: 06/28/2024] Open
Abstract
We report four cases of isolated fallopian tube torsion (IFTT) successfully treated with laparoscopic surgery over the past 10 years. Two young women (each 19 years old) were IFTT with paraovarian cyst (POC) and tubal preservation was possible with detorsion and cystectomy. The other two patients (a 41-year-old woman with hydrosalpinx and a 50-year-old woman with hematosalpinx) underwent salpingectomy and adnexectomy, respectively, because there was no desire for tubal preservation. One patient had emergency surgery due to severe abdominal pain, one had semi-emergency surgery due to mild abdominal pain, and the other two were diagnosed during scheduled surgery without symptoms.Although IFTT was considered a very rare disease, our case series and recent reports suggest that it may have been underestimated, as it accounts for approximately 10% of adnexal torsion cases. Preoperative diagnosis of IFTT may be more difficult than for adnexal torsion because of its infrequency and nonspecific, vague clinical symptoms. Since the prevalent age for this disease is young, as in our first 2 patients, early surgical intervention to preserve the fallopian tubes should be chosen when necessary, and it seems to be important for gynecologists to be aware of this disease for earlier diagnosis and appropriate surgical intervention.
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Affiliation(s)
- Riho Yazawa
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital
| | - Hiroyuki Yazawa
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital
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Bollettini T, Molinaro F, Benigna A, Ciardini E, Centini G, Calomino N, Fusi G, Mario M, Angotti R. Hydatid of Morgagni in Young Female: A Rare Case of Acute Abdomen-Case Report and Literature Review. Case Rep Obstet Gynecol 2024; 2024:4559795. [PMID: 39006407 PMCID: PMC11245333 DOI: 10.1155/2024/4559795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 03/04/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Torsion of the hydatid of Morgagni is a rare condition which can cause acute abdominal pain in young female. We present a case report of a 13-year-old girl with acute abdominal pain and treated for torsion of the hydatid of Morgagni. Less than 20 cases of female younger than 18 years old with this condition are been described in the literature. Through our systematic review performed following the PRISMA statement, we want to emphasize the difficulty in diagnosis and the importance of considering this pathology in the differential diagnosis of acute abdomen in females with the aim of obtaining a timely surgical treatment to preserve fertility in these patients.
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Affiliation(s)
| | | | | | | | | | | | - Giulia Fusi
- Pediatric SurgeryUniversity of Siena, Siena, Italy
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Nakamata A, Matsuki M, Watanabe Y, Kobayashi R, Fujii N, Kunitomo N, Otake Y, Fujii H, Hamamoto K, Mori H. Imaging Features of Uncommon Entities That Manifest with Torsion. Radiographics 2024; 44:e230101. [PMID: 38870044 DOI: 10.1148/rg.230101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Torsion is the twisting of an object along the axis, and various structures (organs and tumors) in the body can twist. Torsion causes initial lymphatic and venous outflow obstruction, leading to congestive edema, enlargement, venous hemorrhagic infarction, and surrounding edema. It can also cause subsequent arterial obstruction depending on the degree of torsion, leading to ischemia, infarction, necrosis, gangrene, and surrounding inflammation. Therefore, in several cases of torsion, immediate surgical intervention is required to improve blood flow and prevent serious complications. Clinical manifestations of torsion are often nonspecific and can affect individuals of varying ages and sex. Imaging plays an important role in the early diagnosis and management of torsion. Multiple imaging modalities, including US, radiography, CT, and MRI, are used to evaluate torsion, and each modality has its specific characteristics. The imaging findings reflect the pathophysiologic mechanism: a twisted pedicle (whirlpool sign), enlargement of the torsed structures, reduced blood flow, internal heterogeneity, and surrounding reactive changes. The whirlpool sign is a definitive characteristic of torsion. In some cases, despite poor internal enhancement, capsular enhancement is observed on contrast-enhanced CT and MR images and is considered to be associated with preserved capsular arterial flow or capsular neovascularization due to inflammation. Radiologists should be familiar with the pathophysiologic mechanisms, clinical characteristics, and imaging characteristics of torsion in various structures in the body. Since other articles about common organ torsions already exist, the authors of this article focus on the uncommon entities that manifest with torsion. ©RSNA, 2024.
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Affiliation(s)
- Akihiro Nakamata
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Mitsuru Matsuki
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Yuriko Watanabe
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Ryoma Kobayashi
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Nana Fujii
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Naoki Kunitomo
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Yuko Otake
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Hiroyuki Fujii
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Kohei Hamamoto
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
| | - Harushi Mori
- From the Department of Radiology, Jichi Medical University School of Medicine, Tochigi, Japan (A.N., Y.W., R.K., N.F., N.K. Y.O., H.F., K.H., H.M.); and Department of Pediatric Radiology, Jichi Children's Medical Center, 3311-1, Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan (M.M.)
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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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7
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Zhang Y, Zhu Q, Wu P, Wu H, He L, Hua L, Zhou J. Thirty-eight cases of paraovarian cysts in children and adolescents: a retrospective study. Pediatr Surg Int 2024; 40:62. [PMID: 38430253 DOI: 10.1007/s00383-024-05656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Paraovarian cysts in children and adolescents can be challenging to accurately diagnose prior to surgery. Our objective is to outline the clinical characteristics of paraovarian cysts and enhance the precision of diagnosing paraovarian cysts in this age group. METHODS We retrospectively analyzed all patients with paraovarian cysts who underwent surgery in our department from 2013 to 2021. The review focused on demographic characteristics, clinical manifestations, intraoperative findings, and postoperative pathology of these patients. RESULTS This cohort was composed of 38 children with paraovarian cysts. The average diameter of the cysts was 4.8 cm (range 0.5-10 cm). Among the cases, 25 (65.8%) had adnexal torsion. Postoperative pathology showed that all cases were simple cysts with serous fluid. After the procedure, the patients were monitored for a period ranging from 12 to 108 months. B-ultrasound and physical examination did not reveal any significant abnormalities. CONCLUSIONS B-ultrasound can help diagnose paraovarian cysts by detecting slight deviation movement between the cyst and the uterus. The presence of adnexa torsion in children and adolescents with paraovarian cysts does not depend on BMI, but rather on the size of cysts. Laparoscopic cyst removal has proven to be an effective surgical approach with favorable outcomes.
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Affiliation(s)
- Yang Zhang
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiang Zhu
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peng Wu
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiyan Wu
- Department of Pathology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lili He
- Department of Pathology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lichun Hua
- Department of Ultrasound Diagnosis, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Zhou
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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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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Pignataro JN, Schindler L. Isolated Fallopian Tube Torsion: Diagnosis and Management of a Gynecologic Emergency. Cureus 2023; 15:e46260. [PMID: 37908916 PMCID: PMC10615115 DOI: 10.7759/cureus.46260] [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: 03/12/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Isolated fallopian tube torsion (IFTT) is a rare gynecologic emergency that requires a high index of suspicion and immediate surgical intervention. IFTT is rarely diagnosed preoperatively due to the lack of pathognomonic signs and symptoms. A 15-year-old female with no medical history presented with acute lower abdominal pain, nausea, and a physical exam significant for diffuse abdominal tenderness to palpation. Ultrasound revealed a large cystic adnexal mass with patent vascular flow to the ipsilateral ovary. Vital signs were stable and laboratory evaluation was unremarkable. Due to an uncertain diagnosis and suspicion of incomplete ovarian torsion, a laparoscopy was performed, which revealed an IFTT and ipsilateral hemorrhagic ovarian cyst. Treatment consisted of unilateral salpingectomy with cystectomy. IFTT is a surgical emergency with nonspecific signs and symptoms. A high degree of clinical suspicion is needed for prompt management. Diagnostic laparoscopy can be a useful tool in the setting of an uncertain diagnosis.
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Affiliation(s)
- John N Pignataro
- Clinical Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Lynnett Schindler
- Obstetrics and Gynecology, Liberty University College of Osteopathic Medicine, Lynchburg, USA
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Arias Rivera AS, Zamora Duarte LM, Shuchleib Chaba S, Chousleb Kalach A, Jalak Cababie M, Shuchleib Cung A. Isolated Fallopian Tube Torsion with Necrotic Hemorrhagic Cyst in an 11-Year-Old Girl Diagnosed by Laparoscopy. Case Rep Surg 2023; 2023:8928662. [PMID: 37592926 PMCID: PMC10432034 DOI: 10.1155/2023/8928662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Isolated fallopian tube torsion (IFTT) is a rare pathology that causes acute abdomen in women, it is even less common in pediatric patients. We present a case of an 11-year-old girl who presented with abdominal pain 24 hours of evolution, the diagnosis could not be specified with cabinet methods, so the definitive diagnosis was made using a diagnostic laparoscopy. A necrotic hemorrhagic tubal cyst was found. A left salpingectomy had to be performed due to necrosis. Early diagnosis can have a positive impact on the fertility of these patients.
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Singh S, Agarwal I, Begum J, Bhardwaj B. The burden of paraovarian cysts - a case series and review of the literature. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2023; 22:105-110. [PMID: 37674926 PMCID: PMC10477768 DOI: 10.5114/pm.2023.128054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/09/2022] [Indexed: 09/08/2023]
Abstract
Introduction A paraovarian cyst (POC) is a cyst in the broad ligament or mesosalpinx. Paraovarian cysts have an estimated prevalence of 5-20% amongst the adnexal masses. Despite the high prevalence and availability of advanced imaging modalities, an accurate pre-operative diagnosis of POC is still made in less than 50% of patients. Case reports Two females with suspected ovarian torsion underwent laparotomy and had POCs. A 42-year-old hysterectomized female underwent surgery for a suspected POC which turned out to be a mesenteric cyst. Two females underwent laparotomy for suspected mesenteric cysts which turned out to be POCs. A nulliparous female with infertility conceived spontaneously after cystectomy of POC. Results Optimal management of an adnexal mass depends on the knowledge of the origin and the exact nature of the mass. No clear-cut guidelines exist for the management of POCs despite their high prevalence. There is a need for further research on this topic to formulate clear-cut guidelines for their management. Conclusions Radiologists and gynaecologists need to keep them in mind as differentials for patients with adnexal masses to ensure a correct pre-operative diagnosis in order to achieve an optimal outcome for these females. Gynaecologists need to be aware of the cases which can be managed conservatively and those that need surgery, along with the extent of the surgery required, taking care to protect the ovary at all costs, particularly in benign cases.
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Affiliation(s)
- Sweta Singh
- All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ishita Agarwal
- All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jasmina Begum
- All India Institute of Medical Sciences, Bhubaneswar, India
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Thanasa A, Thanasa E, Xydias EM, Kamaretsos E, Paraoulakis I, Ziogas AC, Grapsidi V, Kontogeorgis G, Gerokostas EE, Thanasas I. Pueperal Paratubal Cyst Torsion and Secondary Fallopian Tube Torsion Without Ovarian Involvement: A Case Report. Cureus 2023; 15:e36540. [PMID: 37090280 PMCID: PMC10121261 DOI: 10.7759/cureus.36540] [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] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Paratubal cyst torsion accompanied by secondary isolated fallopian tube torsion without involvement of the ipsilateral ovary is rare. A similar case occurring in the postpartum period has not been reported to date in the English literature. Our case report concerns a pregnant multiparous woman in the 40th gestational week, without regular antenatal care attendance, who was urgently admitted to the maternity ward with pushing labour pains and gave birth with vaginal delivery. A few hours later, puerperant complained of worsening severe lower abdominal pain, accompanied by nausea, dizziness and vomiting, unresponsive to analgesic medication. Based on the clinical and ultrasound findings, the diagnosis of an ovarian cyst torsion was established, and it was decided to treat the patient with surgery and in particular with laparotomy. Intraoperatively, in the left parametrium, the presence of an ovoid mass with a brownish-red hue and a smooth outer surface was detected, along which the ipsilateral fallopian tube ran, without the involvement of the ovary. Histological examination of the surgical specimen confirmed the diagnosis of isolated fallopian tubal torsion with paratubal cyst. The postoperative course was uneventful. In this paper, based on modern data, a brief literature review of this rare nosological entity is attempted, regarding the diagnostic and therapeutic approach, the immediate application of which can ensure the best prognosis.
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Affiliation(s)
- Anna Thanasa
- Department of Anatomy, Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Efthymia Thanasa
- Department of Histology, Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Emmanouil M Xydias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, Thessaloniki, GRC
| | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Apostolos C Ziogas
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa, GRC
| | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | | | | | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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13
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Khan A, Alsaied A, Islam M, AlAnsari KM. Adolescent female with right lower abdominal pain. J Am Coll Emerg Physicians Open 2023; 4:e12889. [PMID: 36685310 PMCID: PMC9841120 DOI: 10.1002/emp2.12889] [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: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Abdullah Khan
- Department of Emergency MedicineSidra Medical and Research CentreDohaQatar
| | - Amer Alsaied
- Pediatric SurgerySidra Medical and Research CentreDohaQatar
| | - Muhammad Islam
- Department of Emergency MedicineSidra Medical and Research CentreDohaQatar
| | - Khalid M. AlAnsari
- Department of Emergency MedicineSidra Medical and Research CentreDohaQatar
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14
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Singh K, Aloke, Mandal S. Torsion of fallopian tube with gangrenous ovary and early pregnancy: A rare case report. J Family Med Prim Care 2022; 11:5686-5688. [PMID: 36505632 PMCID: PMC9731036 DOI: 10.4103/jfmpc.jfmpc_1225_21] [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: 06/21/2021] [Revised: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022] Open
Abstract
Torsion of the fallopian tube during early pregnancy is a very rare phenomenon. Most of them present with acute abdominal pain and are often misdiagnosed with a twisted ovarian cyst, ectopic pregnancy, appendicitis, etc. A 19-year-old female was referred to the medical department for pain abdomen, nausea, and vomiting. Her last menstrual period was 28 days back. The urine pregnancy test was negative. Ultrasonogram (USG) was suggestive of encapsulated exophytic hemorrhagic cyst in the right adnexa arising from the right ovary. A huge right-twisted fimbrial cyst with hemorrhagic contents (14 cm × 12 cm) along with a gangrenous right ovary was evident in emergency laparotomy. Right salpingo-oophorectomy was performed. She was discharged with an uneventful postoperative recovery. She presented again after 2 months with postoperative amenorrhea, nausea, and vomiting. USG suggested 12 weeks of pregnancy, which continued until term. Eventually, a lower segment cesarean section was done for fetal distress. A twisted fallopian tube during pregnancy is a rare phenomenon. A high index of suspicion necessitates prompt diagnosis and prevention of future fertility and obstetric morbidity.
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Affiliation(s)
- Komal Singh
- Department of Obstretics and Gynaecology, Tata Central Hospital, Dhanbad, Jharkhand, India,Address for correspondence: Dr. Komal Singh, Tata Central Hospital, Bhaga, Dhanbad 828 301, Jharkhand, India. E-mail:
| | - Aloke
- Department of Medicine, Tata Central Hospital, Dhanbad, Jharkhand, India
| | - Sanchita Mandal
- Department of Obstretics and Gynaecology, Tata Central Hospital, Dhanbad, Jharkhand, India
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15
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Stefanopol IA, Baroiu L, Neagu AI, Danila DM, Nechifor A, Miulescu M, Balan G, Vasile CI, Niculet E, Tatu AL. Clinical, Imaging, Histological and Surgical Aspects Regarding Giant Paraovarian Cysts: A Systematic Review. Ther Clin Risk Manag 2022; 18:513-522. [PMID: 35516165 PMCID: PMC9064068 DOI: 10.2147/tcrm.s361476] [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: 02/08/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Abstract
Paraovarian cysts (POCs) develop within the broad ligament of the uterus. POCs are considered to be giant when the threshold of 150 mm is exceeded. Clinical signs and symptoms occur as a consequence of the pressure effect on adjacent organs or due to complications. Abdominal ultrasonography, computed tomography or magnetic resonance imaging are useful imaging tools, but most often the exact origin of such voluminous cysts is revealed only by surgical exploration. The review aims to appraise and update the diagnostic, the histological aspects and the treatment of the giant POCs in rare cases. We carried out a systematic search in Medline-PubMed, Google Scholar and ResearchGate electronic databases. Twenty-seven papers fulfilling the selection criteria were included in the review. The data extracted included information about first author, year of publication, country, patient age, size and side of the POCs, symptoms, tumoral markers, imaging methods, preoperative diagnosis, surgical management and histopathological findings. Although not very numerous, all the studies highlighted the low incidence of giant POCs, the impossibility of establishing the origin of the cystic mass by clinical and imaging methods even with advanced technical tools and the low risk of torsion (11.1%). Despite the recognized benign nature of POCs, we found an unexpected high percent (25.9%) of borderline giant POCs. Surgical excision is the only treatment option. Ovarian-sparing surgery was performed in 85.1% of the cases, and minimally invasive techniques were applied in only 42.9% of the patients, which demonstrates the need of a high-level laparoscopic expertise. Knowledge of this pathology, its recognition as a possible etiology of an abdominopelvic cyst, and a higher awareness of the possibility of a borderline histology in giant POCs are required for the proper management of these particular cases.
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Affiliation(s)
- Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Department of Pediatric Surgery and Orthopedics, "Sf Ioan" Clinical Emergency Hospital for Children, Galați, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Infectious Diseases Department, "Sf Cuv Parascheva" Clinical Hospital of Infectious Diseases, Galați, Romania
| | - Anca-Iulia Neagu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Department of Anatomopathology, "Sf Ioan" Clinical Emergency Hospital for Children, Galați, Romania
| | - Dumitru Marius Danila
- Department of Pediatric Surgery and Orthopedics, "Sf Ioan" Clinical Emergency Hospital for Children, Galați, Romania.,Clinical Surgical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Magdalena Miulescu
- Research Center in the Functional Cardiorespiratory and Neuromotor Exploration, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Department of Gastroenterology, "Sf Ap Andrei" Emergency County Clinical Hospital, Galați, Romania
| | - Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,"Elena Doamna" Clinical Hospital of Psychiatry, Galaţi, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Department of Pathology, "Sf Ap Andrei" Emergency County Clinical Hospital, Galați, Romania
| | - Alin Laurenţiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, Galați, Romania.,Dermatology Department, "Sf Cuv Parascheva" Clinical Hospital of Infectious Diseases, Galați, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research MIC DIR, Dunarea de Jos" University, Galati, Romania
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16
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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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