A rare, unusual case of isolated fallopian tube torsion reported in NEJM

Dr L.M. Lim, and Dr Harvard Z. Lin at National University Hospital, Singapore, Singapore have reported a rare case of Fallopian tube torsion. The case has appeared in the New England Journal of Medicine.

Isolated torsion of the Fallopian tube is a rare gynaecological cause of acute lower abdominal pain, and diagnosis is difficult. There are no pathognomonic symptoms; clinical, imaging, or laboratory findings. Diagnosis is therefore often delayed until laparoscopy after which time it is often too late to salvage the tube from irreversible ischaemic damage. The mainstay of treatment is salpingectomy given that it often presents late with necrosis and irreversible damage, however, an attempt to untwist the tube should be considered with an aim to regain fertility in women of reproductive age.

A 19-year-old woman (gravida 0, para 0) presented to the emergency department with severe abdominal pain that had started 9 hours earlier. On examination, the abdomen was soft and not distended without guarding, but rebound tenderness was present in the suprapubic and left iliac fossa regions. A urine test for beta-human chorionic gonadotropin was negative.

A computed tomographic scan of the abdomen and pelvis showed a hypodense structure adjacent to the left ovary and a small amount of free fluid in the paracolic gutters. A transvaginal ultrasound examination revealed an adnexal cystic structure adjacent to the left ovary, measuring 4.2 cm by 2.2 cm. Because adnexal torsion was suspected, diagnostic laparoscopy was performed. During the procedure, the left fallopian tube was noted to be dilated, dusky, and twisted three times. Both ovaries and the right fallopian tube were normal. Detorsion of the left fallopian tube was performed; however, it still appeared to be unhealthy, and a left salpingectomy was performed. Histopathological examination revealed hydrosalpinx with no evidence of cancer, granulomas, or endometriosis. The patient recovered uneventfully after surgery.

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