Isolated tubal torsion: A rare cause of acute pelvic/abdominal pain among adolescent females

Abstract

Tubal torsion usually occurs as a part of adnexal torsion that affects an ovary and the adjacent tube; however, isolated tubal torsion is an extremely rare condition. Usually, it presents as acute pelvic/abdominal pain but could also exhibit milder intermittent pain alternating with periods of relief (subacute). This condition has seldom been diagnosed preoperative and commonly results in tubal damage due to delayed management. We hereby, report the findings of two cases managed recently at our center. In both cases, the diagnosis was delayed 2–3 days and was only made intraoperative when the tubes could not be salvaged due to extensive necrosis. The extent of tubal damage is predominantly dependent on the duration of vascular insult; hence, the urgency for affecting early diagnosis and intervention to restore blood supply and preserve tubal integrity and function. We advocate the liberal and early use of laparoscopy in patients presenting with subacute unexplained pelvic/abdominal pain.

Fallopian tube autoamputation after acute large endometrioma torsion

“…[ 3 ] Isolated Fallopian tube torsion was the first to be described in 1890, and it affects roughly one in every 1.5 million women. [ 4 5 ] In adults, Fallopian tube torsion risk factors have been classified into intrinsic and extrinsic factors. Intrinsic risk factors include congenital Fallopian tube defects, tubal ligation, tubal neoplasms, hydrosalpinx, hematosalpinx, excess tube length or tortuosity, excessive peristalsis, and tubal hypermobility or spasm.…”

“…Intrinsic risk factors include congenital Fallopian tube defects, tubal ligation, tubal neoplasms, hydrosalpinx, hematosalpinx, excess tube length or tortuosity, excessive peristalsis, and tubal hypermobility or spasm. [ 4 5 6 ] Extrinsic risk factors encompass para tubal or ovarian masses, pelvic adhesions, mesosalpinx congestion, abrupt body motions, trauma, and pregnancy. These risk factors are assumed to create a hinge around which the Fallopian tube will twist one or more times.…”

“…These risk factors are assumed to create a hinge around which the Fallopian tube will twist one or more times. [ 4 5 6 ] Without timely intervention, torsion can result in ovarian injury, loss of tubal function, and infertility due to chronic autoamputation. [ 3 ] However, in our case, the patient presented with acute pain due to endometrioma torsion concurrently with the left Fallopian tube autoamputation.…”

Isolated Tubal Torsion in a Patient Presented with an Acute Abdominen Clinic

“…Doppler Ultrason ile tanıya gidilebilecek olsada over torsiyonunda olduğu gibi net bir bulgu ortaya koyamayabilir. 3 Over torsiyonunda olduğu gibi, doğrudan görselleştirme tanı için en güvenilir yöntem olmaya devam etmektedir. 3 Bilgisayarlı Tomoğrafi ve Manyetik Rezonans gibi görüntüleme yöntemlerinin tanıya katkısı tartışmalıdır.…”

“…3 Over torsiyonunda olduğu gibi, doğrudan görselleştirme tanı için en güvenilir yöntem olmaya devam etmektedir. 3 Bilgisayarlı Tomoğrafi ve Manyetik Rezonans gibi görüntüleme yöntemlerinin tanıya katkısı tartışmalıdır. 4 İzole edilmiş tubal torsiyonun preoperatif radyolojik tanısında, normal bir yumurtalık görüntüsü ve bir girdap belirtisini gösteren kıvrımlı bir tüp görünümüne sahip dilate bir tüp çok önemlidir.…”