2083278 Isolated Tubal Torsion; Review of 5 Cases

Abstract

Fallopian tube torsion is a rare cause of acute abdomen, occurring commonly in females of reproductive age. It lacks pathognomonic symptoms, signs, or imaging features, thus causing delay in surgical intervention. We report 5 cases of isolated fallopian tube torsion in varying age group from adolescent girl to post menopausal women. We report 5 cases who presented with acute pelvic pain for ultrasound. One patient was premenarchal, two reproductive age group and two were post menopausal. Three patients gave H/O tubal ligation. All patient were scanned on philips HD11 color Doppler machine.Scanning was done transabdominally first with C2-5 convex transducer and then transvaginally using C8-4v endoluminal transducer. In one unmarried patient transrectal scanning was done. All patients showed convoluted, oval, tortuous, thick walled adnexal cystic lesion on the side of pain. There were internal echoes within. In three patients typical whirlpool sign was observed. All patients were operated and diagnosis of torsion was confirmed. Torsion of the tube without an ovarian torsion is termed as isolated fallopian tube torsion (IFTT). Isolated torsion of a fallopian tube can be precipitated by intrinsic and extrinsic etiologies. The intrinsic pathologies are pelvic inflammatory disease, hydrosalpinx, prior tubal surgery, and primary fallopian tube malignancy. The extrinsic pathologies are scarring from endometriosis, prior pelvic surgery, gravid uterus, malignancy or tumor of the adjacent structures, and paraovarian or paratubal cysts. The term “idiopathic”or primary torsion refers to the absence of the above mentioned precipitating etiologic factors. In our series three patients had intrinsic tubal factor (tubal ligation) whereas two patients had no obvious risk factor. Isolated tubal torsion should be included in the list of differential diagnoses of pelvicpain in women of any age group. Since the medical history and physical examination findings may not be suggestive, pelvic US is the modality of choice. In Correlation with clinical findings and using Ultrasonography criteria, one can make a specific diagnosis of tubal torsion and hence not requiring any further imaging modality to prove the same.