Torsion of a unilateral
hydrosalpinx in a virgin: an
uncommon presentation
: A Case report
By: Prof. Hesham A.F. Salem (MD)
Presented by:
Dr. Fady M. Shawky
Ob Gyn
Alexandria University
 The
Fallopian
tube
rarely
undergoes torsion on its own, even
with the presence of a considerable
hydrosalpinx.
 In the reproductive age group, the
ovary commonly shares in a torsion
process and the presentation is
commonly a complicated “twisted
“adnexa.
Isolated torsion of
the Fallopian tube
was
originally
described
by
Bland-Sutton
in
1890
 Pre-operative diagnosis is rather difficult,
owing to the lack of specific symptoms,
signs and/or specific imaging or laboratory
characteristics.
 The introduction of laparoscopy for routine
use in gynaecology has changed the
diagnostic and therapeutic approaches of
Fallopian tube torsion.
CASE REPORT
 A 18-year-old virgin presented with
recurrent, lower abdominal pain taking an
acute turn over the past 5 days.
 Gynecologic, medical and surgical history
were unremarkable.
On examination
 Afebrile and Normotensive.
 Deep tenderness in the left iliac fossa.
 Per vaginal examination revealed a tense
cystic tender mass in the left adnexa.
Investigations
Laboratory tests were all normal.
 Normal serum markers for ovarian Neoplasia.
 Ultrasound revealed a cystic mass in the left
adenexal region with intervening soft tissue.
 Laparoscopy revealed a dusky-blue twisted
left hydrosalpinx. With no coexisting ovarian
torsion.
The adnexal fat planes were clean with no
evidence
of
tuberculosis.
endometriosis,
PID
or
Left Salpingectomy was done.
 Histopathological
examination revealed
tubal dilatation with epithelial flattening and
foci of haemorrhage within the wall.
 This case was unusual in that the presentation
was on the left side, and in the teenage group,
making it a rare presentation of a rare entity.
 Many reports indicate that torsion of the Fallopian
tube is more common on the right side which be
due to the presence of the sigmoid colon on the
left side or to the slow venous flow on the right
side. One the other hand, more cases of right
sided pain are operated because of the suspicion
of appendicitis, whereas left sided cases may be
missed or resolve spontaneously.
Proposed aetiologies for Fallopian tube torsion :
Anatomical abnormalities: (long mesosalpinx,
tubal
abnormalities,
haematosalpinx,
hydrosalpinx)
Physiological
abnormalities:
(abnormal
peristalsis , hypermotility of tube, or tubal
spasm)
Haemodynamic
abnormalities:
(venous
congestion in the mesosalpinx);
Others: trauma, previous surgery or disease
(tubal ligation, pelvic inflammatory disease);
Conclusion
Difficult pre-operative diagnosis made
retrospective diagnosis is usually the
case after diagnostic laparoscopy,
which remains the reference standard
in diagnosis and treatment.
Fallopian
tube
torsion,
though
uncommon, should be included in the
differential diagnosis of acute lower
abdominal pain.
Torsion of a unilateral
hydrosalpinx
Thank you