2022 Volume 38 Issue 2 Pages 199-203
Fallopian tube torsion secondary to an adnexal tumor presents with nonspecific symptoms, and preoperative diagnosis is challenging. We report two cases of hydrosalpinx and paraovarian cyst with accompanying fallopian tube torsion that clinically presented with recurrent mild lower abdominal pain.
Case 1: A 35-year-old woman presented with recurrent mild abdominal pain, one year prior to presentation. Evaluation revealed a right adnexal tumor (59 mm). Abdominal pain had resolved at the time of her visit, and she underwent periodic follow-up to monitor the tumor. She returned with recurrent abdominal pain, and magnetic resonance imaging (MRI) revealed chronic adnexal pedicle torsion. Therefore, she underwent laparoendoscopic single-site surgery (LESS). The right fallopian tube showed hydrosalpinx and was twisted eight times, which necessitated its resection.
Case 2: A 35-year-old woman reported a history of a left adnexal tumor (43 mm) for which she underwent follow-up, 3 years prior to presentation. She currently presented with recurrent mild lower abdominal pain before menstruation and defecation. MRI revealed a left adnexal tumor, and we performed LESS. We observed left fallopian tube torsion (twisted six times) together with a paraovarian cyst. Detorsion led to improved color and restoration of blood flow. The left paraovarian cyst was removed.
An adnexal tumor that presents with recurrent mild abdominal pain is a useful diagnostic clue for suspected tubal torsion. Preoperative diagnosis based on imaging studies is challenging, and intraoperative observation is necessary for definitive diagnosis. For intraoperative observation, LESS is a useful diagnostic and therapeutic tool associated with favorable cosmetic results.
