Isolated fallopian tube torsion: A rare twist with a diagnostic challenge that may compromise fertility

Abstract

Isolated Fallopian tube torsion (IFTT) is a rare entity with utmost important gynecological emergency with difficult preoperative diagnosis. Our aim is to analyze the clinical presentation, risk factors, and management of IFTT. We retrospectively analyzed all patients with intraoperative diagnosis of IFTT in our endogynecological department over a time period of 3 years and 6 months (January 2015–June 2018) in a tertiary level laparoscopic center. The clinical profile of the patients was analyzed and the results formulated. Statistical analysis was done by SPSS system, Version 15.00 (SPSS Inc., Chicago). A total 17 cases were diagnosed with IFTT with or without pathology. The mean age was 28.07 ± 11.3 years. Lower abdominal pain was the most common symptom (88%). About 47% had a history of tubal ligation. Salpingectomy was done in the majority of the patients (82.3%). Detorsion and preservation of the tube was possible in 17.6% of the cases. High index of suspicion is needed to diagnose this rare cause of acute abdomen. Hence, an early intervention can enhance the salvageability of the affected tubes which has a positive impact on the fertility status of the patients. Tubal preservation is the preferred procedure of choice whenever feasible.

Torsion hematosalpinx concurrent with acute appendicitis

“…Hence, whenever we encounter an adnexal torsion, IFTT should be in patients with a previous history of tubal ligation, with an elongated cystic mass, who have a sudden onset of abdominal pain or pelvic pain. 4 Timely intervention in the form of surgery may salvage the fallopian tube in case fertility is desired and prevent other sequel of torsion even if fertility is not desired. Laparoscopy is preferred as it is minimally invasive and it also helps in diagnosis of any other pathology and operative intervention at the same time if needed.…”

“…Devi et al suggested that most of the torsions are noted in the distal two-third of the tube, and believed that the complete salpingectomy is better than partial whenever it is necessary because the proximal nonfunctional part of the tube can be a site of ectopic pregnancy or reformation of hydrosalpinx if it gets occluded and removal of only ampulla and fimbria and keeping the nonfunctional portion is of no use and may increase the risk of recurrence. 4…”

“…3 Tubal ligation has also been reported as one of the predisposing factors for IFTT (Isolated Fallopian Tube Torsion). 4 Clinical features of acute appendicitis may mimic that of right sided adnexal torsion such as acute lower abdominal pain, vomiting, tenderness on examination. Ultrasound helps to differentiate them.…”

Isolated Fallopian Tube Torsion: An Underdiagnosed Entity with Debatable Management

“…Some suggest that hydrosalpinx, which can appear after IFTT, could impair fertility more than salpingectomy itself. (10,11,12) It is not clear whether IFTT is as rare as reported in literature, or if it is widely under-diagnosed. In any event, it seems that under-diagnosis may lead to late laparoscopy possibly affecting future fertility.…”

Isolated Torsion of the Fallopian Tube: a case report

“…Presenting symptoms of isolated torsion of the fallopian tube include acute onset of lower abdominal pain accompanied by nausea, vomiting, and peritoneal signs [7] . It is important in immediate diagnosis and treatment to maintain the fallopian tube [8] . There are many case report about isolated tubal torsion, including Kolovos, Antoniu, Kardakis, Toyoshima, Gross, Raziel that are different from our case [3,7,[9][10][11] , because in this case, Isolated torsion of the left tube occurs without any abnormality and pathology.…”