Isolated fallopian tube torsion with paraovarian cysts: a case report and literature review

Abstract

Background Isolated fallopian tube torsion (IFTT) is a rare cause of gynecological acute abdomen, is easily misdiagnosed and often has a delay in diagnosis. IFTT with paraovarian cysts is most frequently reported in studies. Here, we reported a patient diagnosed with IFTT associated with a paraovarian cyst, and we conducted a literature review for IFTT, aiming to identify valuable information that will be helpful for diagnosis and treatment for fallopian tube torsions. Case presentation A 13-year-old girl presented with a 10-day history of right lower abdominal pain that worsened 2 days before presentation. On presentation, ultrasound showed a 5.8 * 5.5 cm hypoechoic cyst adjacent to the right ovary, and between the cyst and ovary, a tortuous thickened tube was visualized. Laparoscopy revealed a triple torsion of the right fallopian tube with a 6-cm paraovarian cyst, and tubal conservation surgery was performed. The postoperative course was uneventful. Histopathological diagnosis revealed serous papillary cystadenoma. Conclusion Paraovarian cystic dilatation often occurs in adolescence and can induce fallopian torsion when the size of the cyst reaches 5-cm. In our review, the median age of patients diagnosed with IFTT with paraovarian cysts was 15 years old, and the main clinical manifestation was emergency abdominal pain. The associated symptoms were variable, and vomiting was the most commonly associated symptom. Salpingectomy was the most common procedure performed; however, timely surgical intervention can effectively avoid salpingectomy.

Adolescent female with right lower abdominal pain

“…If clinical suspicion of adnexal torsion is high and ultrasound is normal, magnetic resonance imaging or diagnostic laparoscopy can be considered. 3 In our patient the ultrasound identified a cyst with normal color doppler of both ovaries but, owing to persistent pain, laparoscopy was performed and torsion of fallopian tube secondary to para‐ovarian cyst was identified (Figure 1B ). In summary, para‐ovarian cyst can cause torsion of adnexal structures.…”

Computed tomography findings of chronic isolated fallopian tube torsion: a case description

“…Some studies have suggested that right fallopian tube torsion is more common than left fallopian tube torsion because the left side is thought to be fixed by the sigmoid mesentery ( 4 , 6 ). However, according to a recent review, most cases of tubal torsion occur on the left side (14/20) ( 3 ), which contradicts the previously held view. Notably, our case also happened to occur on the left side.…”

“…Continuous torsion leads to obstruction of arterial blood supply, which in turn leads to tubal ischemic necrosis ( 2 ). Patients with IFTT may present with various types of abdominal pain—acute or subacute, intermittent or persistent, severe or mild—and are often accompanied by vomiting ( 3 ). Diagnosis of IFTT is often delayed due to these nonspecific clinical manifestations, leading to adnexectomy, which can affect fertility.…”

Torsion of fallopian tube with gangrenous ovary and early pregnancy: A rare case report

“…[ 11 ] A high index of suspicion is required to diagnose this uncommon condition which can be confirmed and managed only after laparotomy. [ 12 ]…”