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(a) Transvaginal ultrasound showed an echo-free cystic lesion, 5.3 cm × 5.8 cm without septations, located in the right adnexal area. (b) Laparoscopic examination revealed a dark-red, round-shaped cystic lesion that twisted at the infundibulo-pelvic ligament site with adhesion to the right posterior surface of uterus.
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Figure 1: (a) Transvaginal ultrasound showed an echo-free cystic lesion, 5.3 cm × 5.8 cm without septations, located in the right adnexal area. (b) Laparoscopic examination revealed a dark-red, round-shaped cystic lesion that twisted at the infundibulo-pelvic ligament site with adhesion to the right posterior surface of uterus.

Mentions: A 70-year-old postmenopausal woman presented with a 1-week history of lower abdominal pain and discomfort. She had undergone total knee replacement 1 year earlier. Her obstetric history was unremarkable, with no history of tubal sterilization. On examination, she was afebrile and normotensive. Her vaginal examination revealed a tense mass in the right adnexa. Ultrasound revealed a well-defined, echo-free cystic mass measuring 5.3 cm × 5.8 cm without septations (Figure 1a). Her blood count and erythrocyte sedimentation rate were normal. Serum markers of ovarian malignancy were obtained and found to be within normal limits.

Isolated Torsion of the Hydrosalpinx in a Postmenopausal Woman

Ding DC, Hsu S, Kao SP - JSLS (2007 Apr-Jun)

Bottom Line: Torsion of the hydrosalpinx is rare in postmenopausal women.The case was unusual in the postmenopausal age group, making it a rare presentation of a rare entity.Laparoscopy could be a useful tool in diagnosing and treating isolated tubal torsion.

Affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC. dah1003@yahoo.com.tw

ABSTRACT

Objectives: Isolated torsion of the fallopian tube is an uncommon cause of acute lower abdominal pain. It is often found in reproductive-age women and is found less in prepubertal and perimenopausal women.

Methods: We describe a 70-year-old postmenopausal woman who presented with lower abdominal pain and discomfort. Ultrasonography revealed a well-defined, echo-free cystic mass measuring 5.3 cm x 5.8 cm without septations. Laparoscopic examination showed a dark-red, round-shaped cystic lesion that twisted at the right infundibulo-pelvic ligament site in the right adnexa area with adhesion to the posterior uterine surface and separation from the atrophic ovary.

Results: The pathology study of the excised tumor showed hydrosalpinx with torsion. The patient was asymptomatic after the procedure. Torsion of the hydrosalpinx is rare in postmenopausal women. In postmenopausal women presenting with low abdominal pain with an adnexal mass, the gynecologist should contemplate possible torsion of the hydrosalpinx.

Conclusion: The case was unusual in the postmenopausal age group, making it a rare presentation of a rare entity. Laparoscopy could be a useful tool in diagnosing and treating isolated tubal torsion.

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