Isolated fallopian tube torsion in term pregnancy

A 28-year-old second-gravida, with a history of a previous miscarriage, was admitted at 37.3 weeks of gestation due to severe abdominal pain. The pain was acute and occasionally associated with uterine tightness. 

The lady had no fever, nausea, vomiting, or prior history of similar pain. Her menstrual periods were regular before pregnancy, and her antenatal check-ups were uneventful. 

The physical examination revealed that the pain was primarily located in the right middle abdomen, 2 cm from the umbilicus. She carried a term-sized uterus, mildly irritable, with a fetus in cephalic presentation and a regular fetal heart rate of 160 beats/min. 

Upon vaginal examination, she was 1 cm dilated with 40% effacement and the vertex at -3 station, indicative of early labor. The admission hematocrit was 32%, with a TLC of 13,000/mm3 and 80% neutrophils. No abnormalities were detected in the urine. 

As she progressed into labor, fetal distress emerged, leading to emergency lower segment cesarean section (LSCS). During the procedure, a 6x3 cm gangrenous, necrosed, and congested right fallopian tube was discovered, along with mild hydrosalpinx. Post-delivery, the uterus was closed, and a salpingectomy was performed due to the unsalvageable condition of the tube. The left fallopian tube, both ovaries and the appendix showed no abnormalities.

Histological examination revealed recent congestion, necrosis, and hemorrhage in the fallopian tube wall, indicative of torsion. The postoperative period was uneventful, and the patient was discharged on the 3rd postoperative day with a subsequent uneventful follow-up.

While torsion of the fallopian tube in pregnancy is rare, it should be considered as the differential diagnosis of acute abdomen. Imaging techniques, although suggestive, may not be confirmatory. In cases where ultrasound does not confirm the diagnosis, MRI can aid in establishing an accurate diagnosis. Early diagnosis is crucial for preserving the tube, but it remains challenging due to the nonspecific nature of symptoms.

Source: Tyagi S. New Indian J of OBGYN. 2023;10(1)