Ischemic fallopian tube necrosis with hydatid of Morgagni secondary to post‑caesarean intra‑abdominal adhesions entrapment in the 36th week of pregnancy: A case report and mini‑review of the literature

Abstract

Surgical adhesions in the pelvis are a well-known complication following cesarean sections. The present study describes a unique case involving acute intra-abdominal inflammation due to ischemic necrosis of the fallopian tube with a hydatid of Morgagni, resulting from entrapment in post-operative adhesions and leading to preterm labor. The patient described herein, a woman in her 36th week of pregnancy with a history of two prior lower-segment cesarean sections, presented with diffuse abdominal pain escalating in intensity and intermittent vomiting. A diagnosis of preterm labor was established, prompting a decision to proceed with cesarean section. The procedure was uneventful, revealing numerous post-operative pelvic adhesions intraoperatively. Further examination revealed ischemic necrosis of the left fallopian tube with a small hydatid of Morgagni, attributed to entrapment due to an adhesion, with no involvement of the left ovary. Upon dissecting the adhesion, tubal perfusion was promptly restored. A decision was made to preserve the affected fallopian tube and perform surgical drainage of the hydatid of Morgagni. Both the mother and newborn were discharged in excellent condition from the clinic on the 4th post-operative day. The case descrbied herein underscores the rarity of preterm labor resulting from ischemic tubal necrosis with a hydatid of Morgagni, secondary to post-cesarean section adhesions. It emphasizes the importance of an intraoperative examination for tubal and ovarian conditions to detect surgical adhesions and underscores the value of preoperative diagnosis and the prevention of post-operative adhesions in pregnant women undergoing cesarean section.

Keywords: cesarean section; diagnosis; intra-abdominal surgical adhesions; ischemia; management; necrosis; preterm delivery; tubal entrapment.

Figure 1

Intraoperative image illustrating the left fallopian tube and ovary upon inspection for intra-abdominal surgical adhesions following fetal delivery and closure of the uterine incision: Ischemic necrosis of the left fallopian tube and hydatid of Morgagni are evident, without the involvement of the left ovary. This condition is a consequence of their entrapment in a postoperative (post-cesarean section) adhesion (indicated by blue arrow).

Figure 2

Intraoperative image of the left fallopian tube and ovary after dissection of the post-operative (post-cesarean section) adhesion: Immediate revascularization in the left adnexal area led to the decision to spare the inflamed and edematous affected fallopian tube and surgically drain the small hydatid of Morgagni.