Torsion of the Fallopian tube in postmenopausal women

Isolated torsion of the fallopian tube with hydrosalpinx mimicking a multiloculated ovarian cyst: whirlpool sign on preoperative sonography and MRI

Isolated torsion of the fallopian tube is a rare case of lower abdominal pain. Early diagnosis of such cases is crucial because it allows for the possibility of salvage surgery and the prevention of irreversible vascular damage. However, diagnosis is rarely made before surgery due to nonspecific clinical and imaging features. We report a case of isolated tubal torsion with specific imaging findings on preoperative ultrasonography, color Doppler ultrasonography, and magnetic resonance imaging that was misdiagnosed as a multiloculated ovarian cyst at a local hospital.

Isolated torsion of the fallopian tube: the sonographic whirlpool sign

OBJECTIVE

The purpose of this series is to describe the sonographic features of isolated torsion of the fallopian tube.

METHODS

Sonography was performed in 4 women with acute lower abdominal pain.

RESULTS

The uterus and ovaries were normal in the 4 women. The ipsilateral fallopian tube was distended with fluid. A round mass was seen close to the tube. A sonographic whirlpool sign was seen on rocking movement of the probe over the mass. Ipsilateral torsion of the fallopian tube was confirmed at surgery in all of them.

CONCLUSION

The sonographic whirlpool sign is the specific sign of tubal torsion.

Chronic isolated fallopian tube torsion

OBJECTIVE

To describe a case of chronic isolated fallopian tubal torsion in a woman without identifiable risk factors and discuss the difficulty of diagnosis.

DESIGN

Case report.

SETTING

University-based reproductive endocrinology and infertility center.

PATIENT(S)

Multiparous woman with no risk factors of torsion of the fallopian tube presenting with chronic right lower quadrant pain.

INTERVENTION

Laparoscopy with subsequent salpingectomy.

MAIN OUTCOME MEASURE(S)

Resolution of symptoms. Preservation of ovary and future fertility.

RESULT(S)

Patient's symptoms resolved after salpingectomy. Information regarding future fertility is pending.

CONCLUSION(S)

Isolated fallopian tube torsion is rare and often difficult to diagnose. Despite ultrasonographic evidence of arterial and/or venous flow to the adnexa, adnexal torsion cannot be ruled out. If clinical suspicion for torsion is high, early diagnosis and treatment via laparoscopy is encouraged as a means of preserving fallopian tube integrity and maintaining fertility, especially in reproductive-age women.

Isolated torsion of the hydrosalpinx: a rare presentation

Isolated torsion of the Fallopian tube is a rare occurrence, which generally presents in the reproductive age group. It is difficult to diagnose on imaging and the diagnosis is established after laparoscopy. This report describes an unusual presentation of an uncommon condition in a perimenopausal 48-year-old woman who presented with lower abdominal discomfort. The clinical and imaging features led to a suspicion of ovarian neoplasm. Diagnostic laparoscopy revealed torsion of a left sided hydrosalpinx with benign serous cystadenoma of the left ovary. Torsion of the Fallopian tube is a rare event in the perimenopausal age group. It should however be included in the differential diagnosis of lower abdominal pain and recognition of imaging features may allow early surgical intervention.

Adnexal torsion and pulmonary embolism: case report and review of the literature

The classical teaching was that twisted adnexa should be resected and not untwisted, so as not to increase the risk of pulmonary embolism (PE). A patient recently was seen who developed PE after adnexal resection. Because this complication followed the conventional management of salpingo-oophorectomy, the literature was examined for cases of adnexal torsion and PE to see if the operative management (untwisting vs. excision without untwisting) could be implicated as a contributing factor. Three hundred nine cases of adnexal torsion managed by untwisting and 672 cases treated by adnexectomy without detorsion (untwisting) were found. The incidence of PE after adnexal torsion was 0.2 percent, and this incidence was not increased when the adnexa were untwisted. Therefore, we conclude that detorsion of twisted adnexa does not increase the risk of PE, compared with excision without untwisting. PE does occur in cases in which adnexal resection is performed without untwisting. Thus, detorsion of twisted adnexa should be considered at laparoscopy or laparotomy without fear of increasing the incidence of PE.

Torsion of the fallopian tube; a case report of a bilateral non-simultaneous torsion and a review of the literature

The history is described of a patient with bilateral non-simultaneous torsion of the fallopian tubes occurring 10 yr after sterilization and with an interval of 1 yr. A review of the literature is presented which highlights the incidence, the clinical picture, the etiology, the prevention and the treatment of tubal torsion.

Torsion of the uterine adnexa: A clinicopathologic correlation

Although uterine adnexal torsion is a rare phenomenon and an infrequent diagnosis, there have been several reported cases. Two cases that occurred in our practice in the past year are presented to illustrate the acute and chronic phases of the disease. This paper discusses the intrinsic and extrinsic concepts of etiologic factors of adnexal torsion and reviews the common presenting symptoms and the physical, laboratory and pathologic findings of this syndrome. An increased index of suspicion of intermittent adnexal torsion may lead to laparoscopic diagnosis and conservative therapy.

Torsion of the fallopian tube

Although an infrequent cause of acute lower abdominal pain, fallopian tube torsion should be considered whenever a woman presents with this complaint. Early diagnosis and surgical intervention may save a tube that has not yet infarcted, yet initial presentation may give little indication of the seriousness of the condition until peritonitis develops. Definitive treatment is removal of the affected adnexa. Diminished fertility and an increased incidence of ectopic pregnancy in the remaining fallopian tube follows unilateral salpingectomy. A case history of fallopian tube torsion is presented.