Isolated tubal twist: A case series of a rare event occurring at different times in reproductive life

Abstract

Introduction and importance: Isolated fallopian tube torsion (IFTT) is a rare but potentially serious cause of pelvic pain in women. Despite being a surgical emergency, this diagnosis is often overlooked before surgery. To raise awareness of this diagnosis among clinicians, we describe here five cases, which occurred at different times in reproductive life.

Cases presentation: We present five cases of isolated fallopian tube torsion at different ages (13-54 years). It often manifests with sudden onset of acute pelvic pain in four cases and chronic pelvic pain in one case. At admission, patients were suspected of adnexal torsion (3 cases), genital infection (1 case), and renal pain (1 case). CT-scan showed IFTT in only one patient. Laparoscopic surgical management, performed by experienced surgeons, consisted of salpingectomy in 4 cases and conservative treatment in one case. The latter was complicated with hydrosalpinx 6 years later. All patients were followed in outpatient clinic at least one time after surgery and had favorable outcomes.

Clinical discussion: Given the rarity of the pathology and the lack of pathognomonic imaging, IFTT is rarely diagnosed before surgery. Its etiology is still unknown but hydrosalpinx following an infectious process seems to be a major risk factor.

Conclusion: Increasing awareness of this rare entity is advocated, especially in woman of reproductive age. Torsion should be evoked in front acute pelvic pain in patients with hydrosalpinx or paratubal cyst. Conservative management must be privileged especially in women of childbearing age and in pediatric population.

Keywords: Adnexal mass; Adnexal torsion; Case reports; Isolated fallopian tube torsion; Tubal torsion.

Fig. 1

a. Suprapubic ultrasound view: hypoechoic image evocative of tubal origin with incomplete septations. b. Laparoscopic view of the necrotic fallopian tube. c. Surgical specimen, right salpingectomy. The arrow indicates the ostium and the circle indicates the tubal cyst.

Fig. 2

a. Initial ultrasound view showing serpiginous fluid-fluid tubular mass. b. Abdominopelvic CT-scan show mass between the bladder and the uterus. c. laparoscopic view showing isolated tubal twist with hyroslapinx. d. surgical specimen. The arrow indicates the ostium.

Fig. 3

a. Abdominopelvic CT-scan view, visualization of elongated structure interpreted as hydrosalpinx. b. Suprapubic US view showing showing a normal‐appearing ovary with a suspected paraovarian cyst. c. laparoscpic appearance of twisted fallopian tube.

Fig. 4

a. Transvaginal ultrasound showed an aperistaltic echo-free tubular image with incomplete septations. b. CT-scan showing retro uterine lesion with extension to the retro-uterine pouch. c. Laparoscic view of isolated twisted tube with hematosalpinx. d. Surgical specimen.

Fig. 5

Pyosalpinx, late complication of conservative traitement of Isolated torsion of fallopian tube. Transvaginal ultrasound (a) and CT scan (b) findings, with corresponding laparoscopic appearance (c).