Torsion of distal right hydrosalpinx in a primiparous woman at term: A case report

Abstract

Introduction and importanceAdnexal torsion is a significant cause of acute pelvic pain and a common gynaecological emergency. While ovarian cysts are well-recognized predisposing factors, hydrosalpinx is a less common precursor. This case report presents a unique instance of isolated fallopian tube torsion accompanied by hydrosalpinx. Case presentationA 27-year-old primiparous woman at 37 weeks gestation presented with severe right lumbar pain. The patient's vital signs were stable, and abdominal and vaginal examinations were conducted. Imaging confirmed a progressing pregnancy and a 7.5 cm hemorrhagic cystic formation on the right side. Suspecting adnexal torsion, she underwent an urgent cesarean section and surgical exploration, which revealed a twisted distal right hydrosalpinx—the treatment involved detorsion, right salpingectomy, and ovarian suspension. Postoperative recovery was uneventful with histopathological confirmation of hydrosalpinx. DiscussionIsolated fallopian tube torsion is rare, particularly during pregnancy. This condition's etiopathogenesis involves rotation of the tube around its ligamentous supports, possibly exacerbated by factors such as hydrosalpinx, pregnancy, and anatomical variances. Despite the availability of imaging techniques, diagnosis remains challenging, often confirmed only during surgical intervention. The literature highlights the importance of considering this diagnosis in pregnant women with acute pelvic pain and identifying characteristic ultrasound features. ConclusionsIsolated tubal torsion in pregnancy is an exceptional clinical challenge. Early and accurate diagnosis is critical to prevent irreversible damage to the fallopian tube and preserve fertility. This case underscores the need for awareness among clinicians and provides insights into the effective management of such cases.