Pediatric and adolescent fallopian tube torsion: diagnosis and management in a case series of five precoitarchal patients

Abstract

Pediatric and adolescent fallopian tube torsion, whether isolated or accompanied by ovarian torsion, is a rare gynecologic surgical emergency in which the diagnosis is frequently delayed due to nonspecific symptoms, threatening patients’ fertility. Early identification of fallopian tube torsion and timely intervention are crucial for tubal preservation. Therefore, it is important to analyze the clinical features, diagnostic challenges, and outcomes of isolated fallopian tube torsion in the pediatric population. This is a single-center retrospective case series of 5 precoitarchal patients aged 8–19 years (who had never experienced vaginal intercourse) with surgically confirmed fallopian tube torsion: four had isolated fallopian tube torsion (IFTT), and one had simultaneous ovarian and tubal torsion. All patients presented with acute abdominal pain; four had gastrointestinal symptoms (e.g., nausea and vomiting). Physical examination revealed localized tenderness corresponding to the site of abdominal pain in four patients and peritoneal signs in one. Pelvic ultrasonography detected adnexal pathology in all patients but provided only a nonspecific diagnosis; however, magnetic resonance imaging demonstrated a tortuous hemorrhagic fallopian tube in one patient, a finding suggestive of isolated fallopian tube torsion. Salpingectomy was required in 4 of 5 cases, with the only successful tubal salvage occurring in the patient with the shortest symptom duration (10 h). Isolated fallopian tube torsion in pediatric patients is frequently misdiagnosed, leading to high salpingectomy rates. The shortest reported pain duration coincided with tubal preservation in one patient, but this single case with concomitant ovarian torsion cannot establish a duration–outcome relationship. Prompt surgical assessment remains important. High clinical suspicion, timely advanced imaging, and prompt surgical intervention are critical for preserving fallopian tube in pediatric isolated fallopian tube torsion. Pediatric and adolescent fallopian tube torsion is a rare surgical emergency in which diagnosis is frequently delayed owing to non-specific symptoms. Affected patients are seldom diagnosed preoperatively, and salpingectomy is often necessary in these nulliparous women. The interval from symptom onset to surgery is possibly associated with the rate of salpingectomy, early diagnosis and surgical intervention are essential for tubal preservation. Heightening clinical awareness of gynecological pathology in girls with acute abdominal pain (for which pelvic ultrasound can be helpful), including IFTT in the differential diagnosis for gynecological emergencies, appropriately broadening the indications for MRI and performing diagnostic laparoscopy promptly when clinical suspicion persists may improve clinical outcome.