Isolated twisted hematosalphinx misleading with ovarian cyst torsion

Abstract

Normal or chronically inflamed fallopian tube can undergo torsion and present as acute abdomen, simulating clinically as ectopic gestation. Torsion of the fallopian tube is less frequent but significant cause of lower abdominal pain in reproductive age women that is difficult to recognize preoperatively. Authors present a rare case of hematosalpinx with torsion at its pedicle with hemoperitonium who presented as 28 years old female with acute abdomen that was successfully treated. In cases presenting with hemoperitoneum diagnosis of ruptured ectopic pregnancy should be made unless proved otherwise during reproductive age. Rarely ruptured ovarian cyst may also be a cause. Unfortunately, hematosalpinx sometimes can undergo torsion due to circulatory imbalance and can present as hemoperitoneum and circulatory collapse due to rupture. There have been no specific symptoms, clinical findings, imaging or laboratory characteristics identified for this condition. Imaging findings are non-specific in the preoperative diagnosis of torsed fallopian tubes. Therefore, most of cases with isolated fallopian tubal torsion had a delayed diagnosis and a subsequent delay of timely intervention that may result in failure to save tubal function. Torsion of tube can lead to hematosalpinx, hemoperitonium and necrosis of tube which necessitates urgent surgical management. This case report describes a twisted hematosalpinx presentation without any predisposing high-risk factors. A tubal torsion should be suspected in females with acute pelvic pain, of any age group. An early diagnosis and treatment are required to prevent complications. This rare case may highlight a new insight into pathogenesis of tubal torsion associated with hematosalpinx.

Torsion of hematosalpinx with bicornuate uterus

“…A number of causes may account for a hematosalpinx, but by far the most common being a tubal pregnancy. 2 In the presence of predisposing factors, the adnexal veins and the lymphatic vessel are prone to a mechanical blockage, leading to a local oedema and a pelvic congestion. The subsequent enlargement of the adnexa predisposes to a partial or complete torsion, along with the formation of a hydrosalpinx.…”

Torsion hematosalpinx concurrent with acute appendicitis

“…Immediate detorsion is always recommended, because it is unclear how long a patient has sustained torsion until irreversible damage occurs. 7 Laparoscopic detorsion of tube is the treatment of choice whenever feasible to preserve the fertility. Whenever fertility is not desired, salpingectomy should be the procedure of choice.…”