Isolated twisted hematosalphinx misleading with ovarian cyst torsion

Normal or chronically inflamed fallopian tube can undergo torsion and present as acute abdomen, simulating clinically as ectopic gestation. Torsion of the fallopian tube is less frequent but significant cause of lower abdominal pain in reproductive age women that is difficult to recognize preoperatively. Authors present a rare case of hematosalpinx with torsion at its pedicle with hemoperitonium who presented as 28 years old female with acute abdomen that was successfully treated. In cases presenting with hemoperitoneum diagnosis of ruptured ectopic pregnancy should be made unless proved otherwise during reproductive age. Rarely ruptured ovarian cyst may also be a cause. Unfortunately, hematosalpinx sometimes can undergo torsion due to circulatory imbalance and can present as hemoperitoneum and circulatory collapse due to rupture. There have been no specific symptoms, clinical findings, imaging or laboratory characteristics identified for this condition. Imaging findings are non-specific in the preoperative diagnosis of torsed fallopian tubes. Therefore, most of cases with isolated fallopian tubal torsion had a delayed diagnosis and a subsequent delay of timely intervention that may result in failure to save tubal function. Torsion of tube can lead to hematosalpinx, hemoperitonium and necrosis of tube which necessitates urgent surgical management. This case report describes a twisted hematosalpinx presentation without any predisposing high-risk factors. A tubal torsion should be suspected in females with acute pelvic pain, of any age group. An early diagnosis and treatment are required to prevent complications. This rare case may highlight a new insight into pathogenesis of tubal torsion associated with hematosalpinx

Torsion hematosalpinx concurrent with acute appendicitis

Isolated fallopian tube torsion is very rare which is reported to be 1 in 1.5 million women. Fallopian tube torsion is commonly associated with hydrosalpinx, hematosalpinx or paratubal cysts such as hydatids of Morgagni. Fallopian tube torsion generally presents a diagnostic dilemma because symptoms and signs mimics ovarian torsion such as acute lower abdominal pain, vomiting, tenderness on palpation but ultrasound may show normal ipsilateral ovary. Right sided adnexal torsion may be difficult to differentiate from acute appendicitis clinically. In such cases ultrasound is helpful but diagnostic laparoscopy is gold standard. We encountered a rare case of torsion hematosalpinx concurrent with acute appendicitis. Patient was presented with acute onset severe lower abdominal pain associated with vomiting and tenderness in right iliac fossa. It was diagnosed as acute tip appendicitis and right adnexal cystic mass either hydrosalpinx/hematosalpinx in ultrasonography. Laparoscopy was done and it was found to be right sided torsion hematosalpinx along with inflamed tip of appendix. Right sided salpingectomy and appendicectomy was done laparoscopically. Fallopian tube torsion should be suspected and diagnostic laparoscopy should be considered in cases of acute onset lower abdominal pain in which ovarian pathology was not found in ultrasonography, that helps in earlier intervention and even in early cases fallopian tube can be salvaged

MRI diagnosis of tubal torsion: the whirlpool sign

Isolated fallopian tube torsion is a rare cause of acute lower abdominal pain with multiple described contributory factors resulting in tubal necrosis and gangrene. While clinical presentation is nonspecific with a wide clinical differential diagnosis, a combination of sonographic or MRI whirlpool sign with a dilated fallopian tube and normal appearing ipsilateral ovary helps make a preoperative diagnosis of tubal torsion. We report a case of a middle aged female who was diagnosed with tubal torsion on preoperative MRI and is the first description of MRI whirlpool sign for diagnosis of tubal torsion from the Indian subcontinent to our knowledge. The whirlpool mass in tubal torsion is much smaller than ovarian torsion and may be less obvious on ultrasound as in present case

A rare cause of acute abdominal pain in adolescence: hydrosalpinx leading to isolated torsion of fallopian tube

Torsion of the fallopian tube accompanying hydrosalpinx is a rare occurrence in the pediatric population. This report describes a 13 year old sexually inactive girl with isolated tubal torsion due to hydrosalpinx. The girl had lower left abdominal pain for two days. The physical examination revealed left lower quadrant tenderness with a firm round anterior mass on rectal examination. Abdominal ultrasound showed left tubal enlargement with free pelvic peritoneal fluid. Magnetic Resonance Imaging (MRI) showed engorgement and dilatation of the left fallopian tube without contrast enhancement suspicious of tubal torsion. At operation, torsion of the left tube on its longitudinal axis was observed, and a salpingectomy was performed. Although rare, the diagnosis of torsion of the fallopian tube should be considered when evaluating acute abdominal pain. The earlier tubal torsion is diagnosed, the greater the likelihood of salvaging the fallopian tube. (C) 2012 Elsevier Inc. All rights reserved

HEMATOSALPINX TORSION IN AN ADOLESCENT

Introdução: A torção da trompa de Falópio é uma causa rara de dor abdominal aguda. A gravidez ectópica, hidro ou hematossalpinge, endometriose, tumefações anexiais e outras causas de patologia anexial são fatores predisponentes. O diagnóstico é difícil de estabelecer, uma vez que os sinais clínicos, laboratoriais e imagiológicos são pouco específicos. O diagnóstico definitivo requer uma abordagem cirúrgica. Caso clínico: Os autores apresentam um caso de hematossalpinge e torção da mesma numa adolescente virgem sem fatores de risco conhecidos. Discussão: O caso evidencia a importância da reflexão sobre causas de hematossalpinge e recorda esta patologia como diagnóstico diferencial.Introduction: Isolated fallopian tube torsion is an uncommon cause of acute lower abdominal pain. Ectopic pregnancy, hydro or hematosalpinx, endometriosis, adnexal masses and other causes of adnexal disease are predisposing factors. The diagnosis is difficult and often delayed due to the lack of pathognomonic symptoms, characteristic physical signs, and specific imaging and laboratory studies. Definitive diagnosis requires a surgical approach. Case report: The authors present a case of hematosalpinx and its tubal torsion in a virgin teenager with no prior predisposing factors. Discussion: This rare case may highlight a new insight into pathophysiology of tubal torsion and recalls hematosalpinx as a differential diagnosi

A Rare Case of Isolated torsion of Haematosalphinx Presenting as Acute Abdomen During Pregnancy

Isolated fallopian tubal torsion is a rare non obstetric cause for pain abdomen during pregnancy.We report a case of a 34 year old second gravida who presented with history of amennorrhoe of 7 months, colicky pain in the left iliac fossa , with 2 episodes of vomiting. A Trans vaginal scan revealed a left ovarian cyst. An emergency laparotomy was performed for suspected torsion or haemorrhage into an ovarian cyst. Surprisingly ovaries were normal and a congested and necrotic left tubal torsion with a tubal collection (haematosalphinx) was identified and a salpingectomy was then performed. The differential diagnosis is discussed and the literature is reviewed as it is a very rare clinical entity

Torsion in a massive hematosalpinx with a functional rudimentary horn: a rare cause of acute abdomen in adolescence, managed laparoscopically

Congenital anomalies of the female genital tract may remain undiagnosed till adolescence. Unicornuate uterus with a rudimentary horn is rare and found in 1 in 100000 women. A functional rudimentary horn may cause hematometra, hematosalpinx, endometriosis and its complications. This is a case of a 13-year-old girl who had a hematometra in a functional rudimentary horn and a hematosalpinx with torsion giving rise to an acute abdomen and a 16-week mass abdomen. Laparoscopy was done followed by detorsion, salpingectomy and transection of the rudimentary horn. This article should sensitize the need to correct the anomaly while preserving the reproductive potential of the girl. A review of the salient points of laparoscopy in such cases have been further discussed

Isolated torsion of the fallopıan tube in a postmenopausal woman; a rare entity

Isolated torsion of the fallopian tube is an uncommon cause of acute lower abdominal pain. The lack of pathognomonic symptoms, clinical findings on physical examination, and specific imaging or laboratory characteristics makes this entity difficult to diagnose preoperatively, which can cause surgical intervention to be postponed. We report a case of isolated torsion of the right fallopian tube in a 58-year-old woman with a history of sexually transmitted infection. In most reported cases, there is no vascular flow on Doppler imaging modalities. We also detected high impedance of vascular flow around the cyst wall. Imaging modalities could not provide a definitive diagnosis. Tubal torsion was diagnosed upon laparotomy

Isolated torsion of the fallopıan tube in a postmenopausal woman; a rare entity

Isolated torsion of the fallopian tube is an uncommon cause of acute lower abdominal pain. The lack of pathognomonic symptoms, clinical findings on physical examination, and specific imaging or laboratory characteristics makes this entity difficult to diagnose preoperatively, which can cause surgical intervention to be postponed. We report a case of isolated torsion of the right fallopian tube in a 58-year-old woman with a history of sexually transmitted infection. In most reported cases, there is no vascular flow on Doppler imaging modalities. We also detected high impedance of vascular flow around the cyst wall. Imaging modalities could not provide a definitive diagnosis. Tubal torsion was diagnosed upon laparotomy

Laparoscopic management of a cavitated noncommunicating rudimentary uterine horn of a unicornuate uterus: a case report

<p>Abstract</p> <p>Introduction</p> <p>A unicornuate uterus with a rudimentary horn is the most uncommon uterine anomaly of the female genital tract. It has an estimated frequency of one in 100,000 among the fertile female population. This anomaly results from the abnormal maturation of one Müllerian duct with the normal development of the contralateral one.</p> <p>Case presentation</p> <p>We report here the case of a 14-year-old Caucasian girl who came to our hospital with intense dysmenorrhea. Imaging techniques revealed a unicornuate uterus with a rudimentary horn and a large hematosalpinx. We performed a laparoscopic removal of this uterine anomaly without any complication in the postoperative period.</p> <p>Conclusion</p> <p>In our case report, we demonstrate that laparoscopy is the best approach for the treatment of IIb Müllerian abnormalities. Laparoscopy resulted in anatomical and reproductive results equivalent to those offered by a laparotomic approach, but with the additional advantages of minimally invasive surgery, such as better cosmetic results and postoperative period, which are essential for very young patients.</p