Isolated Unilateral Hydrosalpinx Torsion in a Post-Tubal Ligation Patient: A Case Report and Review of Literature

Isolated tubal torsion of the hydrosalpinx is a rare occurrence with a varied clinical presentation, presenting a diagnostic challenge. We present a case involving the isolated torsion of the right hydrosalpinx in a 33-year patient with a history of bilateral tubal ligation who presented with an acute abdomen. Based on ultrasound and clinical findings, an initial diagnosis of ovarian torsion was considered. However, escalating pain severity led to diagnostic laparotomy, revealing torsion in the right hydrosalpinx. Subsequent right salpingectomy was done, and as the patient had undergone tubal ligation, preventive left salpingectomy was also performed. Both ovaries were preserved. The patient experienced an uneventful recovery. A literature review uncovered fewer than 50 reported cases of unilateral or bilateral isolated fallopian tube torsion post-tubal ligation. This case underscores the diagnostic challenges associated with isolated tubal torsion and emphasizes the crucial role of early surgical intervention in preventing morbidity and preserving ovaries.

Not every twist is ovarian torsion: a case report of isolated torsion of the fallopian tube in a child

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.

Fallopian Tube Torsion Secondary to Paraovarian Fimbrial Cyst: A Difficult to Diagnose and a Rare Cause of Acute Abdomen in Adolescent

Fallopian tube torsion secondary to paraovarian or paratubal cyst is a rare gynecological cause of acute abdomen. The condition has no distinctive signs and symptoms. There are no characteristic features on radiological imaging, making preoperative diagnosis very difficult. Paraovarian cysts that are less than 4 cm in size are mostly asymptomatic and found incidentally during a pelvic examination or radiological imaging. It seldom leads to any complications like fallopian tube torsion hemorrhage or rupture. We report a case of an adolescent girl, who presented with severe abdominal pain. Transabdominal ultrasound was suggestive of a cystic structure less than 4 cm in size in the left adnexa. Doppler ultrasound showed normal blood flow to both ovaries. Diagnostic laparoscopy was performed, which revealed a twisted left-sided fallopian tube with a fimbrial paraovarian cyst. Detorsion and paraovarian cystectomy was performed. Although paraovarian cysts are mostly asymptomatic, those arising near the fimbrial end can lead to torsion of the fallopian tube, therefore it should always be considered a possible cause of acute abdomen in adolescent girls with adnexal cysts on ultrasound. Timely surgical intervention can prevent complications such as fallopian tube necrosis, gangrene, removal of the tube, and its long-term implications especially in women of the reproductive age group.

Isolated fallopian tubal torsion: Reproductive age case series

AIM

To present our experiences in isolated fallopian tubal torsion (IFTT) case series, which are difficult to diagnose, in light of the literature.

METHODS

The data of the patients diagnosed with IFTT surgically in our tertiary hospital between 2018 and 2019 were evaluated.

RESULTS

Abdominal lower quadrant pain was present in all nine cases. Abdominal pain was accompanied by nausea in five of the nine cases with vomiting in four of the nine cases. Seven of the patients had pain radiating to the vagina. Only one case of IFTT was diagnosed with transvaginal ultrasonography where left tubal dilation and free fluid in the abdomen was found. Two of the nine cases were operated on with a preoperative diagnosis of IFTT. Seven cases were approached laparoscopically and two cases underwent a laparotomy. During the treatment, two of the nine cases underwent detorsion, while seven of the patients underwent a salpingectomy.

CONCLUSION

IFTT is a very rare condition. Therefore, it is difficult to diagnose as it does not come to mind at first glance. Delay of the operation reduces the chance of preserving the tube.

Isolated Fallopian Tube Torsion With Fimbrial Cyst In A 10 Year-old Girl Diagnosed By Ultrasound: A Case Report

Torsion of the fallopian tube without the involvement of the ipsilateral ovary is a rare but important cause of acute abdominal pain in women as it is a surgical emergency. Although uncommon, it should be considered as one of the differential diagnosis in female children presenting with acute lower abdominal or pelvic pain. The diagnosis of isolated fallopian tube torsion is difficult pre-operatively and is often made during laparoscopic or surgical exploration because diagnostic features are usually non-specific. In this report, we present a case of isolated fallopian tube torsion with fimbrial cyst in a young female patient diagnosed pre-operatively by ultrasound.

Spontaneous bilateral torsion of fallopian tubes presenting as primary infertility

Case presented at "Stump the Professors" 44th American Association of Gynecologic Laparoscopists Global Congress on Minimally Invasive Gynecology, NV, USA, 15-19 November 2015 BACKGROUND: Spontaneous torsion of the fallopian tubes is a rare condition, usually seen in acute settings or as incidental findings during laparoscopy.

PRESENTATION OF THE CASE

A 34-year-old nulligravid woman with inability to conceive for 7 months presented to our center. Her hysterosalpingography revealed a blind-ending right fallopian tube, and a blocked and dilated left fallopian tube. Laparoscopy showed a long, auto-amputated right fallopian tube, disconnected from the fimbriae and a long, dilated left fallopian tube, with several twists around its axis. Bilateral salpingectomy was performed. The patient subsequently underwent IVF, resulting in an ongoing pregnancy.

CONCLUSION

Spontaneous torsion of the fallopian tubes can manifest as primary infertility without any antecedent symptoms, and should be considered in the differential diagnosis of bilateral tubal obstruction.