若年女性に発症した卵管捻転に対して腹腔鏡下卵管切除術を余儀なくされた1例

抄録

[Introduction] Fallopian tube torsion is a rare disease. We report a case of fallopian tube torsion in a young girl.

[Case] The patient was a 12-year-old girl. She had her first menstruation 4 months prior to presentation and did not have a history of sexual intercourse. On her visit to the emergency department, her chief complaint was left lower abdominal pain. Transrectal echography revealed a 3-pack mass approximately 37 mm in size in the left appendage area. Blood test analysis did not reveal any increases in inflammatory response and levels of tumor markers. As the patient reported no exacerbation of the abdominal pain, we deemed that emergency surgery was not necessary and followed up the patient. On the fourth day of hospitalization, still no exacerbation of the left lower abdominal pain occurred. Thus, ovarian torsion was suspected, and emergency surgery was planned for treatment and diagnostic purposes. The intraoperative findings showed that the left fallopian tube was twisted three times counterclockwise. On the basis of these findings, a diagnosis of left fallopian tube torsion was made. After the torsion was released, part of the fallopian tube was found to be necrotic; therefore, the left fallopian tube torsion was not released but, instead, was resected. The patient's postoperative course was uneventful. She was discharged from the hospital 4 days after the operation.

[Conclusion] Fallopian tube torsion is a rare disease. Definitive diagnosis takes time, and saving the fallopian tubes is difficult. From the aspect of fertility, the possibility of fallopian tube and ovarian pedicle twisting should be considered in young patients with acute abdomen, and early positive laparoscopic orientation is desired.