A 19-year-old woman presented to the emergency department with complaints of severe abdominal pain for 9 hours. She had never given birth before nor been pregnant.
On abdominal examination, there was rebound tenderness in the suprapubic and left iliac fossa regions. The rest of the abdomen was soft, non-tender, non-distended, and without guarding or rebound tenderness.
To rule out pregnancy, a urine pregnancy test was done to detect urinary levels of beta-human chorionic gonadotropin. The test was negative. Abdomino-pelvic computed tomographic scan revealed a mass adjacent to the left ovary. A small amount of free fluid was noticed in the paracolic gutters. An adnexal cystic structure was identified on the transvaginal ultrasound adjacent to the left ovary, measuring 4.2 cm by 2.2 cm.
Adnexal torsion was suspected, therefore, diagnostic laparoscopy was performed.
On laparoscopy, a dilated and left fallopian tube was noted, which was twisted around its axis thrice. The rest of the pelvic examination was normal on laparoscopy with normal ovaries bilaterally and normal right fallopian tube. Left salpingectomy was performed because, despite the detorsion, the tube appeared to be unhealthy.
The resected tube was sent for histopathological evaluation, which showed hydrosalpinx only. There was no evidence of cancer, granulomas, or endometriosis.
The procedure and the post-operative period were uneventful, and the patient recovered completely.
Fallopian tube torsion of an otherwise healthy tube is a rare cause of acute pelvic pain. It’s called isolated fallopian tube torsion when the tube torsion is not associated with ipsilateral ovarian involvement.
Diagnostic laparoscopy seems to be the only definitive way of diagnosing the condition. No imaging modality has been considered the gold standard in diagnosing this rare condition. Doppler’s ultrasound cannot diagnose the torsion either, although a pelvic mass becomes visible on the ultrasonography. Owing to this and its vague presentation, the diagnosis is usually delayed to the point where the tube cannot be conserved by detorsion. Irreversible damage occurs till the time the torsion of the tube is diagnosed leading to a salpingectomy.
L.M. Lim, M. B. (2020, January 02). Fallopian Tube Torsion. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1907697
Bora, S. A., Kanapathippillai, R., & Backos, M. (2011). Isolated fallopian tube torsion: an unusual cause of acute abdominal pain. BMJ case reports, 2011, bcr0520114183. https://doi.org/10.1136/bcr.05.2011.4183