Fallopian Tube Torsion

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Image Source: The New England Journal of Medicine

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.

References

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

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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