緊急腹腔鏡下手術前に診断しえた卵管捻転の1例

抄録

  We experienced a case of Fallopian tube torsion that was diagnosed preoperatively. A 47-year-old nulligravida presented at the emergency department of Maebashi Red Cross Hospital with the chief complaint of sudden onset of severe lower abdominal pain just after defecation. On physical examination, severe tenderness and rebound pain in the right adnexa were noted. Computed tomography (CT) showed multilocular images in both adnexa, and magnetic resonance imaging (MRI) suggested bilateral hydro- or hemato- salpinges. Neither pentazocine nor nonsteroidal anti-inflammatory drugs (NSAIDs) relieved her pain. Emergency laparoscopy revealed torsion and convolution of the right Fallopian tube, a left hydrosalpinx, and perihepatic fibrous adhesions. A bilateral salpingectomy was performed. Her postoperative course was uneventful. Pathological examination revealed hemorrhage, severe edema, and partial degeneration of the right Fallopian tube consistent with torsion of the right Fallopian tube; no evidence of malignancy was present. A preoperative test for chlamydial antigen in the cervix was negative. However, serum antibodies for chlamydia trachomatis showed a positive result for IgG and a negative result for IgA; thus suggesting previous existence of chlamydial pelvic peritonitis. The clinical features and images led to the correct preoperative diagnosis, and led to a prompt decision to perform emergency laparoscopic surgery. Fallopian tube torsion, although uncommon, should be included in the differential diagnoses of acute lower abdominal pain in women.