Fallopian Tube Torsion
A 19-year-old woman (gravida 0, para 0) presented to the emergency department with severe abdominal pain that had started 9 hours earlier. On examination, the abdomen was soft and nondistended without guarding, but rebound tenderness was present in the suprapubic and left iliac fossa regions.
A urine test for beta human chorionic gonadotropin was negative. A computed tomographic scan of the abdomen and pelvis showed a hypodense structure adjacent to the left ovary and a small amount of free fluid in the paracolic gutters. A transvaginal ultrasound examination revealed an adnexal cystic structure adjacent to the left ovary, measuring 4.2 cm by 2.2 cm. Because adnexal torsion was suspected, diagnostic laparoscopy was performed. During the procedure, the left fallopian tube was noted to be dilated, dusky, and twisted three times. Both ovaries and the right fallopian tube were normal. Detorsion of the left fallopian tube was performed; however, it still appeared to be unhealthy, and a left salpingectomy was performed. Histopathological examination revealed hydrosalpinx with no evidence of cancer, granulomas, or endometriosis. The patient recovered uneventfully after surgery.