Laparoscopic management of isolated fallopian tube torsion in the second trimester: a case report

Abstract

Abstract Background Isolated fallopian tube torsion is a rare gynecological acute abdomen. Its clinical manifestations and imaging findings are non-specific, making preoperative diagnosis relatively challenging. Isolated fallopian tube torsion during pregnancy is even rarer, as the gravid uterus can cause patients' symptoms and signs to be easily confused with other acute abdominal conditions, such as acute appendicitis. Misdiagnosis, missed diagnosis, or delayed diagnosis may lead to insufficient blood supply or even necrosis of the torsed fallopian tube, ultimately affecting female fertility. Case presentation We report a case of isolated fallopian tube torsion in a 30-year-old Chinese woman who developed lower abdominal pain at 24 weeks of gestation. The pain initially localized to the right lumbar region and subsequently migrated to the right lower quadrant. The patient had a past medical history of right renal calculi and a right fallopian tube mesenteric cyst. Magnetic resonance imaging revealed a cyst approximately 3 cm in diameter in the right adnexal region. Due to the possibility of adnexal torsion, a laparoscopic exploration was performed. Intraoperatively, the right fallopian tube was found to have undergone four twists and appeared dark purple, while the right ovary, left adnexa, and appendix showed no abnormalities. Following detorsion, the tube remained persistently dark purple; consequently, a right salpingectomy was performed. Postoperatively, the patient continued the pregnancy to term and subsequently underwent a cesarean section. Conclusions In women with hydrosalpinx or paratubal cyst presenting with lower abdominal pain, the possibility of isolated fallopian tube torsion should be considered. When isolated fallopian tube torsion is suspected during pregnancy or the diagnosis of acute abdomen remains unclear, timely exploratory surgery is necessary. The decision to preserve the fallopian tube should be based on the degree of ischemia caused by the torsion. Early diagnosis and prompt surgical intervention can prevent necrotic changes due to torsion, thereby preserving the patient's natural fertility.