抄録
Background: Torsion of the adnexa is one of the common causes of an acute abdomen in women; however, its association with an isolated fallopian tube lesion is uncommon. The clinical presentation is often nonspecific, and when there is a need to preserve fertility, prompt diagnosis and surgical detorsion is essential. We describe a case of fallopian tube torsion accompanied by periappendicitis diagnosed and successfully treated with laparoscopy.
Case: A 41-year-old woman with a prior history of an ovarian pseudocyst treated with laparoscopic surgery presented to our ER with a chief complaint of right lower quadrant abdominal pain of three days duration. The physical examination revealed tenderness and rebound tenderness of the lower abdomen. A CBC revealed signs of inflammation. CT showed mildly enlarged appendix and a multicystic 5 cm pelvic mass. The patient was referred to our department; pelvic examination was not helpful in differentiating whether the pain originated from the adnexa or the appendix. Transvaginal ultrasound detected bilaterally normal ovaries. With the pre-operative diagnosis of appendicitis with a pelvic mass, an emergency laparoscopy was performed. A right hydrosalpinx, twisted 720 degrees was noted. The distal end of the fallopian tube was necrotic and partially ruptured. An adhesion was present between the right tube and the mildly enlarged and reddened appendix. Adhesiolysis, tubal detorsion, salpingectomy, and appendectomy were performed. Her postoperative course was uneventful.
Conclusions: Preoperative diagnosis was difficult because the inflammation had extended to both the fallopian tube and appendix. However, minimally invasive laparoscopy enabled adequate diagnosis and treatment.
