Abstract
Adnexal torsion is an uncommon cause of acute abdomen in pregnancy and isolated fallopian
tube twisting accounts for a very small number of these cases. These conditions, either
in pregnancy or in non-gestational circumstances, are known to be due to both genital
and non-genital causes and, in most cases, predisposing factors can be identified.
We reviewed the literature and retrieved only 19 cases of isolated fallopian tube
torsion in pregnancy treated surgically from 1936 to today, including one recently
published case from our experience.
The clinical presentation was lower quadrant abdominal pain in all cases. The right
side was involved in 90% of the cases. Tenderness was usually present but peritoneal
irritation with guarding or rebound was exceptional. Symptoms were nausea and vomiting,
scanty vaginal bleeding and dysuria. Signs suggestive of necrosis such as leucocytosis,
increased CRP and mild hyperpyrexia were uncommon. Preoperative ultrasound evaluation
was performed in eight patients and in all cases an adnexal cyst was detected on the
ipsilateral side of the abdominal pain. The case we recently published was carefully
investigated preoperatively by Doppler flow ultrasound techniques which allowed for
a precise differential diagnosis with total adnexal torsion. This aspect has never
been previously considered. The surgical approach showed acute isolated fallopian
tube torsion in all the cases and a predisposing factor was identified in 75% of the
patients. Foetal and maternal outcome were always excellent.
In cases of acute abdomen in pregnancy, with detailed Doppler flow ultrasound evidence
of normal ovaries and of a pelvic cyst, an isolated tubal-paratubal cyst torsion should
be considered and appropriate ovary-sparing surgical treatment foreseen.
Keywords
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Article info
Publication history
Published online: May 25, 2009
Accepted:
May 5,
2009
Received in revised form:
March 17,
2009
Received:
October 22,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
