Isolated torsion of the fallopian tube in premenarcheal girls

IFTT in children and adolescents-single-center experience and systematic review of literature

PURPOSE

Isolated fallopian tube torsion (IFTT) is defined by rotation of the fallopian tube around itself without involving the ipsilateral ovary. It is a rare cause of acute lower abdominal pain in (adolescent) girls, but is commonly overlooked. Due to its rarity, literature is still scarce. Currently there is no generally accepted management and treatment.

METHODS

A retrospective analysis of all IFTT cases treated in our institution was performed. In addition, a systematic literature research on pediatric IFTT was carried out on Medline/ PubMed database according to PRISMA principles using predefined search terms and inclusion criteria. Patient characteristics regarding age, clinical symptoms, diagnostic methods, treatment, and follow-up were analyzed.

RESULTS

Three of our patients and fifty-nine reports totaling one hundred seventy girls were included in the analysis. Mean age was 13.0 years. Left tube was slightly more often affected (52.9%). Abdominal pain was present in 99.4% of cases accompanied with nausea in 57.1%. In only 16.4%, correct preoperative diagnosis was made. Salpingectomy was the most common treatment in 111 (66.9%) cases, 55 (33.1%) patients were treated with detorsion of the tube (organ-sparing management). Girls with symptoms longer than 1 day had a significant higher rate of salpingectomy (95% CI, P = 0.0323).

CONCLUSION

When IFTT is suspected, emergency laparoscopy should be performed to possibly preserve future reproductive potential. In case of detorsion and reinstated blood supply, organ-preserving management should be performed with simultaneous addressment of concomitant pathology if possible. Sufficient long-term follow-up must be assured to get significant results to introduce guidelines for children and adolescents.

Isolated Fallopian Tube Torsion: A Rare Entity

Isolated fallopian tube torsion is an extremely rare occurrence in a young female. The lady concerned presented with acute abdominal pain and the ovaries were normal on the scan with dilated fallopian tubes. On laparoscopy, it was revealed that she was suffering from fallopian tube torsion and laparoscopic salpingectomy was performed. The patient recovered well postoperatively.

Acute right lower abdominal pain in women of reproductive age: Clinical clues

AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age.

METHODS: Following Clinical Trials Ethical Committee approval, the retrospective data consisting of physical examination and laboratory findings in 290 patients with sudden onset right lower abdominal pain who used the emergency surgery service between April 2009 and September 2013, and underwent surgery and general anesthesia with a diagnosis of acute appendicitis were collated.

RESULTS: Total data on 290 patients were obtained. Two hundred and twenty-four (77.2%) patients had acute appendicitis, whereas 29 (10%) had perforated appendicitis and 37 (12.8%) had gynecological organ pathologies. Of the latter, 21 (7.2%) had ovarian cyst rupture, 12 (4.2%) had corpus hemorrhagicum cyst rupture and 4 (1.4%) had adnexal torsion. Defense, Rovsing’s sign, increased body temperature and increased leukocyte count were found to be statistically significant in the differential diagnosis of acute appendicitis and gynecological organ pathologies.

CONCLUSION: Gynecological pathologies in women of reproductive age are misleading in the diagnosis of acute appendicitis.

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 fallopian tube torsion in pediatric and adolescent females: a retrospective review of 15 cases at a single institution

STUDY OBJECTIVE

To identify and review cases of isolated fallopian tube torsion (FTT) at our institution to further characterize diagnosis and management.

DESIGN

Retrospective review.

SETTING

Tertiary care medical center.

PARTICIPANTS

Case series of pediatric and adolescent females, <21 years old, with operatively diagnosed isolated fallopian tube torsion from our institution.

INTERVENTION

None.

MAIN OUTCOME MEASURE

Isolated fallopian tube torsion.

RESULTS

Fifteen cases of isolated fallopian tube torsion were identified based on intraoperative diagnosis. Patient ages ranged from 8-15 years old, mean age of 12. Fourteen patients (93%) presented with abdominal pain, 8 (53%) localized to the side of associated torsion. Ultrasonography reports described a tubular structure in 4 patients and an associated ovarian or paraovarian cyst in eleven patients. Suspicion of fallopian tube torsion was only described for those patients with a tubular structure described on ultrasonography report. Intraoperatively, 7 patients (47%) were found to have no associated pathology and 8 (53%) were found to have associated cyst or hydrosalpinx. Eight (53%) patients underwent salipingectomy and 7 (47%) underwent reversal of torsion with drainage of associated cyst or cystectomy.

CONCLUSIONS

Isolated fallopian tube torsion is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular structure or an adjacent normal ovary. Management may be considered nonemergent and salpingectomy is controversial. Long-term fertility outcomes must be further assessed for more definitive decisions regarding surgical management.

Laparoscopic treatment of isolated salpingeal torsion in children: case series and a 20-year review of the literature

BACKGROUND

Isolated torsion of the Fallopian tube, without ovarian torsion, is a rare cause of lower abdominal pain. We report our experience with 4 recent cases, along with data from a 20-year review of the pediatric literature.

SUBJECTS AND METHODS

The records of 4 cases encountered during a 3-year period were reviewed. A literature review was completed by searching Medline, Medline in Process, Embase, Current Contents, and BIOSIS from 1990 to 2010.

RESULTS

All 4 patients were diagnosed on laparoscopy. Laparoscopic salpingectomy was performed in 3 cases and laparoscopic detorsion in 1. All three resected specimens revealed hemorrhage and gangrene of the salpinx, with an associated cyst in one. The pediatric literature review, including our report, revealed 33 case reports and case series with 45 patients. Fifty-six percent of cases represented primary torsion, and 44% were secondary to underlying tubal pathology. Thirty percent of girls were premenarchal. The mean age at presentation and symptom duration were 13.2±2.1 years and 5.8±12.5 days, respectively. Fever and leukocytosis were present in 27% and 63%, respectively. Ultrasound, computed tomography scan, and magnetic resonance imaging showed a sensitivity of 22% (8/36), 14% (1/7), and 40% (2/5), respectively. A correct preoperative diagnosis was considered in only 13%. Eighty-eight percent of cases were treated by salpingectomy, and 12% were treated by tubal detorsion. Long-term outcomes of detorsion were not reported.

CONCLUSIONS

Isolated salpingeal torsion in girls is rarely diagnosed preoperatively, regardless of imaging technique. Laparoscopy is the intervention of choice for definitive diagnosis and management. Salpingectomy is the most frequent treatment. Detorsion without resection may be considered for selected cases, but the long-term outcomes of this approach are unknown.

Isolated torsion of the fallopian tube: a case report and review of the literature

Isolated torsion of the fallopian tube is a rare medical emergency, especially in premenarchal girls. We present a 9-year-old girl with right-sided lower abdominal pain. Isolated torsion of the fallopian tube was suspected preoperatively because of the clinical presentation combined with the results of ultrasound and magnetic resonance imaging (MRI). At emergency laparoscopy, the isolated torsion of the fallopian tube could be reduced, and the tube could be salvaged. This case report shows that the use of ultrasonography and MRI or CT is a helpful diagnostic tool to recognize this condition at an early stage. Especially in young girls presenting with abdominal pain, this should be kept in mind, as digital vaginal examination and vaginal ultrasound most often cannot be used in the diagnostic process. In conclusion, because prompt surgical intervention is required to preserve the tube and prevent progression to peritonitis and possible detrimental effects on future fertility, isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain in all female patients regardless of age.

Cannot exclude torsion--a 15-year review

BACKGROUND

Ovarian torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss.

METHODS

Charts of patients with ovarian operative cases were retrospectively reviewed at a free-standing children's hospital over 15 years. Torsion was based on intraoperative findings.

RESULTS

Of 328 operative ovarian cases, 97 (29.6%) demonstrated torsion. Mean patient age was 9.2 years (2 days to 17 years, +/-0.54 SEM), with 52% occurring between 9 and 14 years. Of the patients, 97% presented in pain. Presence of a pelvic mass 5 cm or larger on imaging had 83% sensitivity for torsion: an ultrasound reading was only 51% sensitive. Elevated white blood cell count was the only preoperative characteristic associated with prompt operative intervention. Utilization of laparoscopy increased during the latter half of the study (18%-42%, P < .0434). There was a positive trend, although insignificant, in the use of laparoscopy and ovarian salvage. Pathology was overwhelmingly benign (infarction [46%], cysts [33%], and benign neoplasms [19%]).

CONCLUSION

Torsion was responsible for one third of all operative ovarian cases. Sonography is not reliable in diagnosis or exclusion of ovarian torsion. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL), particularly with a pelvic mass of approximately 5 cm, may improve ovarian salvage. Because pathology is predominantly benign, the edematous detorsed ovary is safe to salvage.

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.

Adnexal masses in infancy and childhood

The presentation of adnexal masses in childhood differs from that in adult women. Children may present with poorly localized symptoms or precocious puberty. Ovarian cysts occur throughout development; ovarian tumors are less frequent but occur in all age groups. Congenital malformations may present with signs or symptoms of an adnexal mass. Occasionally adnexal findings may suggest the presence of an underlying syndrome. Assessment of the patient's developmental, hormonal, and pubertal status is necessary to ensure an accurate diagnosis. Treatment options must consider risks to ovarian function and future fertility.

Isolated tubal torsion managed laparoscopically

Adnexal cystic lesions in women of reproductive age are common. Most are functional ovarian cysts, followed by paraovarian cysts, hydrosalpinx, and adnexal torsion. A 34-year-old woman experienced mild abdominal pain, nausea, and low-grade fever. She received empiric antibiotics in an outpatient clinic after a diagnosis of tubo-ovarian abscess. After 3 days she was referred to our hospital with no improvement in symptoms or signs. Isolated fallopian tube torsion was diagnosed and successfully treated by laparoscopy. Laparoscopy played an important role in making an accurate diagnosis and avoiding unnecessary delays in treatment.

[Fallopian tube torsion in a 15-year-old adolescent]

Isolated Fallopian tube torsion in teenagers is extremely rare and diagnosis is difficult. Coelioscopy is necessary, but surgery often occurs too late for tube conservation.

CASE REPORT

A case of Fallopian tube torsion bringing about a cyst is presented. Diagnostic difficulties, echography, treatment and cause are discussed.

CONCLUSION

Early diagnosis and surgical intervention is mandatory when isolated Fallopian tube torsion is suspected.

Isolated recurrent torsion of the Fallopian tube: case report

We report a rare clinical case of recurrent isolated torsion of the Fallopian tube. An 18 year old woman presented with acute right lower quadrant pain, nausea and vomiting. Torsion of the Fallopian tube was detected by laparoscopy and detorsion was performed. Two years later, a second similar episode of pelvic pain recurred. Having in mind the first episode, diagnosis was facilitated and detorsion was performed in accordance with the patient's wishes. However, the dilemma of ideal management of recurrent cases of torsion of the same tube remains open for discussion. The possibility of torsion of the Fallopian tube and recurrent torsion of the tube, although rare, should be considered in any patient with acute onset of lower abdominal pain.

Laparoscopic and thoracoscopic surgery in children and adolescents: a 3-year experience

Our initial experience over the last 3 years with laparoscopic and thoracoscopic surgery in children and adolescents is reported. Between September 1992 and August 1995, a total of 215 laparoscopic and thoracoscopic procedures were performed: 32 appendectomies for acute appendicitis, 10 cholecystectomies for symptomatic gallstones, 11 procedures for adnexal pathology, 6 laparoscopies in children with nonpalpable testes, 3 diagnostic laparoscopies, and 153 thoracoscopic sympathectomies in children suffering from primary palmar hyperhidrosis. The post-operative course was uneventful in all cases. In 2 children with acute appendicitis we converted to the open technique due to technical difficulties. We are encouraged by the results of our initial experience. There is no doubt that laparoscopic cholecystectomy, laparoscopic surgery of adnexal pathology, and thoracoscopic sympathectomy, because of their numerous benefits - shorter operative time, hospitalization, and convalescence as well as less postoperative pain and improved cosmetic results - are replacing the open techniques. We are not convinced as yet of the advantages of laparoscopic appendectomy in children; we are presently performing both laparoscopic and conventional techniques and studying the various parameters in order to reach a more definite conclusion. Various other endoscopic surgical procedures will be carefully considered in the near future.