ISOLATED FALLOPIAN TUBE TORSION IN AN EARLY ADOLESCENT: A CASE REPORT

Isolated fallopian tube torsion is an infrequent but significant gynecological cause of pelvic pain in female patients, with literature approximating its overall incidence as 1 in 1.5 million women, and incidence of which in pediatric and adolescents is difficult to determine. Locally, there has never been a published paper regarding the condition in young adolescents, emphasizing its rarity.

A 12-year-old female presented with right lower quadrant (RLQ) pain. She was initially treated for urinary tract infection and a whole abdominal ultrasound done prior to referral to the institution showed a cystic structure in the mid-pelvic region and an inflamed appendix. The abdomen was soft with direct and rebound tenderness at the RLQ and hypogastric area. On rectal examination, pelvic organs cannot be fully evaluated due to voluntary guarding. Abdominal CT scan revealed a 10x8.4x7.4cm thick-walled cystic pelvic mass, probably ovarian, and a normal appendix measuring 0.6cm. Assessment was adnexal pathology, probably ovarian. Pelvic laparotomy was performed and upon exploration, there was a hemorrhagic pelvoabdominal mass which measured 13x11x8cm, found to be a cystically enlarged right fallopian tube, twisted once on its vascular pedicle. Upon untwisting, the fimbriated end was noted to be necrotic. The left tube, left ovary and the uterus looked normal. Right salpingectomy was performed.

The entity is difficult to recognize pre-operatively because of its vague clinical presentation. Abdominal tenderness may present with or without peritoneal signs. There may be adnexal tenderness, but a mass is not always palpable. There is no specific laboratory finding and radiologic diagnosis is also limited. Isolated tubal torsion should be considered in cases of acute lower abdominal pain since awareness and early detection of the condition, especially in children and adolescents, allows early surgical intervention that may prevent removal of the tubes and render preservation of fertility.