Isolated torsion of the fallopian tube in a menopausal woman and a pre-pubertal girl: two case reports

Abstract

IntroductionIsolated torsion of the fallopian tube without an ovarian abnormality is an uncommon event, with an incidence of approximately 1 in 1,500,000 females. Isolated torsion of the fallopian tube occurs mostly in reproductive-aged women, and is thus extremely rare in menopausal women and pre-pubertal girls.Case presentationsIn case 1, 63-year-old Japanese woman presented with a 2-day history of acute lower abdominal pain. Menopause occurred at 53 years of age. Pelvic ultrasonography showed an enlarged mass (73 × 47 mm) on the right side of her uterus. An urgent laparoscopy was performed based on a presumptive diagnosis of right ovarian tumor torsion. During the laparoscopy, we noted a black, necrotic, solid tumor arising from the distal end of her right fimbria. Her right fallopian tube was twisted with the tumor, but her right ovary was normal and not involved. A laparoscopic tumorectomy with a right salpingectomy was performed. Her post-operative course was uneventful. In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting. Menarche had occurred 2 months earlier. A computed tomography and magnetic resonance imaging examination demonstrated a dilated tubal cystic mass with a normal uterus and bilateral ovaries. An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tube torsion. During laparoscopy, her right fallopian tube was noted to be dark red, dilated, and twisted several times. Her right fimbria was necrotic-appearing and could not be preserved. Therefore, a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, which was consistent with tubal torsion. She had an uncomplicated post-operative course.ConclusionWe have presented two very rare cases of isolated fallopian tubal torsion. Radiologic interventions, such as computed tomography and magnetic resonance imaging, in addition to ultrasonography, are helpful diagnostic tools. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain with a cystic mass and a normal ipsilateral ovary in all female patients, regardless of age.

Diagnostic laparoscopy in isolated torison of hydrosalpinx: a likely cure for an unlikely disorder

“…[2][3][4][5][6][7] It was first described by Bland-Sutton in 1980s and continues to torment patients and physicians alike by being difficult to diagnose. 8 As in the present case, it is more likely to occur in premenopausal women.…”

“…2 However not all hydrosalpinx lead to torsion as they are preceded by Pelvic Inflammatory Disease (PID) and PID leads to formation of adhesions. Adhesions restrict the mobility of fallopian tubes.…”

“…[1][2][3][4][5][6][7] It is difficult to reach a diagnosis of torsion of hydrosalpinx by clinical features alone or laboratory values, which are nonspecific. [1][2][3][4][5][6][7] Ultrasonography (USG) shows a cyst separate from the ovary but the large size of hydrosalpinx may obscure the ovary and as in our case, it is difficult to differentiate the two on USG. [2][3]9 Retained blood flow to the ovary favors isolated torsion of the fallopian tube.…”

“…[1][2][3][4][5][6][7] Ultrasonography (USG) shows a cyst separate from the ovary but the large size of hydrosalpinx may obscure the ovary and as in our case, it is difficult to differentiate the two on USG. [2][3]9 Retained blood flow to the ovary favors isolated torsion of the fallopian tube. Despite this, making a pre-operative diagnosis of isolated torsion is unlikely.…”

“…1 It often presents as a diagnostic dilemma since there are no pathognomonic clinical, laboratory or radiological features. [2][3][4][5][6][7] Since the advent of laparoscopy, diagnostic laparoscopy has been a handy tool in the work up of abdominal pain.…”