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Isolated torsion of the fallopian tube in a menopausal woman and a pre-pubertal girl: two case reports.

Toyoshima M, Mori H, Kudo K, Yodogawa Y, Sato K, Kudo T, Igeta S, Makino H, Shima T, Matsuura R, Ishigaki N, Akagi K, Takeyama Y, Iwahashi H, Yoshinaga K - J Med Case Rep (2015)

Bottom Line: In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting.Menarche had occurred 2 months earlier.She had an uncomplicated post-operative course.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. m-toyo@med.tohoku.ac.jp.

ABSTRACT

Introduction: Isolated torsion of the fallopian tube without an ovarian abnormality is an uncommon event, with an incidence of approximately 1 in 1,500,000 females. Isolated torsion of the fallopian tube occurs mostly in reproductive-aged women, and is thus extremely rare in menopausal women and pre-pubertal girls.

Case presentations: In case 1, 63-year-old Japanese woman presented with a 2-day history of acute lower abdominal pain. Menopause occurred at 53 years of age. Pelvic ultrasonography showed an enlarged mass (73 × 47 mm) on the right side of her uterus. An urgent laparoscopy was performed based on a presumptive diagnosis of right ovarian tumor torsion. During the laparoscopy, we noted a black, necrotic, solid tumor arising from the distal end of her right fimbria. Her right fallopian tube was twisted with the tumor, but her right ovary was normal and not involved. A laparoscopic tumorectomy with a right salpingectomy was performed. Her post-operative course was uneventful. In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting. Menarche had occurred 2 months earlier. A computed tomography and magnetic resonance imaging examination demonstrated a dilated tubal cystic mass with a normal uterus and bilateral ovaries. An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tube torsion. During laparoscopy, her right fallopian tube was noted to be dark red, dilated, and twisted several times. Her right fimbria was necrotic-appearing and could not be preserved. Therefore, a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, which was consistent with tubal torsion. She had an uncomplicated post-operative course.

Conclusion: We have presented two very rare cases of isolated fallopian tubal torsion. Radiologic interventions, such as computed tomography and magnetic resonance imaging, in addition to ultrasonography, are helpful diagnostic tools. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain with a cystic mass and a normal ipsilateral ovary in all female patients, regardless of age.

No MeSH data available.


Related in: MedlinePlus

Pre-operative and peri-operative images in case 2. a Contrast-enhanced computed tomography shows a dilated fluid-filled tubular structure (arrow). b Sagittal T2-weighted magnetic resonance imaging shows a hyperintense tubular structure (arrow) positioned on the superior aspect of the uterus. c The right fallopian tube was twisted, and the fimbria was dilated, dusky in appearance, and completely necrotic (arrow). F right fimbria, FT right fallopian tube, O right ovary. d After removal of the necrotic fimbria and distal side of the fallopian tube. The uterus and the right ovary were normal. U uterus, FT right fallopian tube, O right ovary
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Fig2: Pre-operative and peri-operative images in case 2. a Contrast-enhanced computed tomography shows a dilated fluid-filled tubular structure (arrow). b Sagittal T2-weighted magnetic resonance imaging shows a hyperintense tubular structure (arrow) positioned on the superior aspect of the uterus. c The right fallopian tube was twisted, and the fimbria was dilated, dusky in appearance, and completely necrotic (arrow). F right fimbria, FT right fallopian tube, O right ovary. d After removal of the necrotic fimbria and distal side of the fallopian tube. The uterus and the right ovary were normal. U uterus, FT right fallopian tube, O right ovary

Mentions: A 10-year-old Japanese girl presented to our Gynecologic Section following a 1-day history of lower abdominal pain associated with nausea and vomiting. She had been well before the onset of the pain. Our patient denied any urinary or bowel symptoms or recent vaginal discharge. Menarche had begun 2 months before. Her medical and family histories were benign. She was not taking any medications and had never used contraceptive pills. She was 149 cm tall and weighed 37 kg. Her blood pressure was 123/71 mmHg and her pulse was 101 beats per minute. Her body temperature was 37.6 °C. On physical examination, tenderness and rebound pain were confined to her right lower quadrant. A trans-abdominal USG showed a 7-cm cystic mass in her right adnexa and a small amount of ascites in the pouch of Douglas. There were no significant findings with respect to her uterus and left adnexa. Laboratory testing showed that her white cell count was markedly increased to 21.6 × 106 cells/mm3, but her C-reactive protein level was 0.2 mg/dL. Tests for tumor makers, including human chorionic gonadotropin, alpha-fetoprotein, CA125, CA19-9, and squamous cell carcinoma-associated antigen were all negative. A trans-vaginal USG and digital examination were not performed because of her age. Computed tomography (CT) demonstrated a dilated and tortuous tubule-like structure in her central pelvis with a weakened contrast effect (Fig. 2a). She was admitted to our pediatric ward with a suspicion of salpingitis or Meckel’s diverticulitis and was prescribed antibiotics. The same signs and symptoms persisted on the next day. Meckel’s diverticulum scintigraphy showed no abnormal accumulation in her pelvis. Magnetic resonance imaging (MRI) revealed normal ovaries and a well-circumscribed mass with a thickened wall without obvious contrast enhancement (Fig. 2b). An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tubal torsion. During laparoscopy, dark-red, necrotic-appearing, edematous right fimbriae were noted with her right fallopian tube dilated and twisted along its axis several times (Fig. 2c). Her right ovary was not involved and was normal in appearance (Fig. 2d). Her uterus and left adnexa were also normal, and no paratubal or paraovarian cysts were noted (Fig. 2d). Her right fallopian tube was irreparably damaged, thus a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, consistent with tubal torsion. Our patient was discharged after surgery and had an uncomplicated post-operative course.Fig. 2


Isolated torsion of the fallopian tube in a menopausal woman and a pre-pubertal girl: two case reports.

Toyoshima M, Mori H, Kudo K, Yodogawa Y, Sato K, Kudo T, Igeta S, Makino H, Shima T, Matsuura R, Ishigaki N, Akagi K, Takeyama Y, Iwahashi H, Yoshinaga K - J Med Case Rep (2015)

Pre-operative and peri-operative images in case 2. a Contrast-enhanced computed tomography shows a dilated fluid-filled tubular structure (arrow). b Sagittal T2-weighted magnetic resonance imaging shows a hyperintense tubular structure (arrow) positioned on the superior aspect of the uterus. c The right fallopian tube was twisted, and the fimbria was dilated, dusky in appearance, and completely necrotic (arrow). F right fimbria, FT right fallopian tube, O right ovary. d After removal of the necrotic fimbria and distal side of the fallopian tube. The uterus and the right ovary were normal. U uterus, FT right fallopian tube, O right ovary
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4647800&req=5

Fig2: Pre-operative and peri-operative images in case 2. a Contrast-enhanced computed tomography shows a dilated fluid-filled tubular structure (arrow). b Sagittal T2-weighted magnetic resonance imaging shows a hyperintense tubular structure (arrow) positioned on the superior aspect of the uterus. c The right fallopian tube was twisted, and the fimbria was dilated, dusky in appearance, and completely necrotic (arrow). F right fimbria, FT right fallopian tube, O right ovary. d After removal of the necrotic fimbria and distal side of the fallopian tube. The uterus and the right ovary were normal. U uterus, FT right fallopian tube, O right ovary
Mentions: A 10-year-old Japanese girl presented to our Gynecologic Section following a 1-day history of lower abdominal pain associated with nausea and vomiting. She had been well before the onset of the pain. Our patient denied any urinary or bowel symptoms or recent vaginal discharge. Menarche had begun 2 months before. Her medical and family histories were benign. She was not taking any medications and had never used contraceptive pills. She was 149 cm tall and weighed 37 kg. Her blood pressure was 123/71 mmHg and her pulse was 101 beats per minute. Her body temperature was 37.6 °C. On physical examination, tenderness and rebound pain were confined to her right lower quadrant. A trans-abdominal USG showed a 7-cm cystic mass in her right adnexa and a small amount of ascites in the pouch of Douglas. There were no significant findings with respect to her uterus and left adnexa. Laboratory testing showed that her white cell count was markedly increased to 21.6 × 106 cells/mm3, but her C-reactive protein level was 0.2 mg/dL. Tests for tumor makers, including human chorionic gonadotropin, alpha-fetoprotein, CA125, CA19-9, and squamous cell carcinoma-associated antigen were all negative. A trans-vaginal USG and digital examination were not performed because of her age. Computed tomography (CT) demonstrated a dilated and tortuous tubule-like structure in her central pelvis with a weakened contrast effect (Fig. 2a). She was admitted to our pediatric ward with a suspicion of salpingitis or Meckel’s diverticulitis and was prescribed antibiotics. The same signs and symptoms persisted on the next day. Meckel’s diverticulum scintigraphy showed no abnormal accumulation in her pelvis. Magnetic resonance imaging (MRI) revealed normal ovaries and a well-circumscribed mass with a thickened wall without obvious contrast enhancement (Fig. 2b). An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tubal torsion. During laparoscopy, dark-red, necrotic-appearing, edematous right fimbriae were noted with her right fallopian tube dilated and twisted along its axis several times (Fig. 2c). Her right ovary was not involved and was normal in appearance (Fig. 2d). Her uterus and left adnexa were also normal, and no paratubal or paraovarian cysts were noted (Fig. 2d). Her right fallopian tube was irreparably damaged, thus a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, consistent with tubal torsion. Our patient was discharged after surgery and had an uncomplicated post-operative course.Fig. 2

Bottom Line: In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting.Menarche had occurred 2 months earlier.She had an uncomplicated post-operative course.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. m-toyo@med.tohoku.ac.jp.

ABSTRACT

Introduction: Isolated torsion of the fallopian tube without an ovarian abnormality is an uncommon event, with an incidence of approximately 1 in 1,500,000 females. Isolated torsion of the fallopian tube occurs mostly in reproductive-aged women, and is thus extremely rare in menopausal women and pre-pubertal girls.

Case presentations: In case 1, 63-year-old Japanese woman presented with a 2-day history of acute lower abdominal pain. Menopause occurred at 53 years of age. Pelvic ultrasonography showed an enlarged mass (73 × 47 mm) on the right side of her uterus. An urgent laparoscopy was performed based on a presumptive diagnosis of right ovarian tumor torsion. During the laparoscopy, we noted a black, necrotic, solid tumor arising from the distal end of her right fimbria. Her right fallopian tube was twisted with the tumor, but her right ovary was normal and not involved. A laparoscopic tumorectomy with a right salpingectomy was performed. Her post-operative course was uneventful. In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting. Menarche had occurred 2 months earlier. A computed tomography and magnetic resonance imaging examination demonstrated a dilated tubal cystic mass with a normal uterus and bilateral ovaries. An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tube torsion. During laparoscopy, her right fallopian tube was noted to be dark red, dilated, and twisted several times. Her right fimbria was necrotic-appearing and could not be preserved. Therefore, a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, which was consistent with tubal torsion. She had an uncomplicated post-operative course.

Conclusion: We have presented two very rare cases of isolated fallopian tubal torsion. Radiologic interventions, such as computed tomography and magnetic resonance imaging, in addition to ultrasonography, are helpful diagnostic tools. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain with a cystic mass and a normal ipsilateral ovary in all female patients, regardless of age.

No MeSH data available.


Related in: MedlinePlus