 |
Case Series
Two cases of isolated tubal torsion: Presentation, evaluation, and management
1 Resident Physician, Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania, United States
2 Attending Physician, Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania, United States
Address correspondence to:
Jordann-Mishael Duncan
MD, Department of Obstetrics and Gynecology, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA,
United States
Message to Corresponding Author
Article ID: 100096Z08JD2021
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Duncan JM, Banks E. Two cases of isolated tubal torsion: Presentation, evaluation, and management. J Case Rep Images Obstet Gynecol 2021;7:100096Z08JD2021.ABSTRACT
Introduction: Isolated tubal torsion is a rare event with an incidence of 1 in 1.5 million women. Predisposing factors of isolated tubal torsion include intrinsic causes such as hydrosalpinx, tubal adhesions, and tubal ligation; extrinsic causes include ovarian masses, pelvic adhesions, and pregnancy. The gold standard for diagnosis and treatment is laparoscopy.
Case Report: The first clinical case is 33-year-old nulliparous female with a history of hydrosalpinx who presented to the emergency department with left lower quadrant pain accompanied by nausea and emesis. Pelvic ultrasound showed a left hydrosalpinx with normal Doppler venous flow to the left ovary. On physical exam, she had severe abdominal tenderness, but no guarding or rebound. She underwent a diagnostic laparoscopy secondary to concern for isolated tubal torsion. On diagnostic laparoscopy a necrotic, torsed left fallopian tube was visualized and left salpingectomy was performed. The second clinical case is a 25-year-old nulliparous female with a past surgical history of a right salpingo-oophorectomy who presented to the emergency department with left lower quadrant pain and nausea. Pelvic ultrasound showed a complex left adnexal mass. After 24 hours of observation, the patient underwent a diagnostic laparoscopy for persistent pain which revealed left isolated tubal torsion for which a left salpingectomy was performed.
Conclusion: Isolated tubal torsion is a rare occurrence but should be included in the differential for a woman presenting with acute abdominal pain, without evidence of ovarian torsion especially if a tubal mass is present on imaging.
Keywords: Acute abdominal pain, Adnexal masses, Hematosalpinx, Hydrosalpinx, Laparoscopy, Pelvic adhesions, Torsion
SUPPORTING INFORMATION
Acknowledgments
I would like to thank Dr. Banks as well as the Pennsylvania Hospital residency program for taking excellent care of these patients
Author ContributionsJordann-Mishael Duncan - Substantial contributions to conception and design, Acquisition of data, Interpretation of data, Final approval of the version to be published
Elizabeth Banks - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Jordann-Mishael Duncan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
