A Rare Case of Torsion of Hydrosalpinx Masquerading as Torsion of the Ovary
Abstract:
Isolated fallopian tube
torsion is an infrequent but significant cause of acute pelvic pain, often
difficult to diagnose pre-operatively due to its symptom overlap with other
conditions such as ovarian cyst torsion and appendicitis. Hydrosalpinx, a condition
typically asymptomatic, can present with acute pain when complicated by
torsion. This case report highlights the diagnostic challenges and management
strategies associated with hydrosalpinx torsion. A 35-year-old woman with a
history of Polycystic Ovarian Disease (PCOD) and previous sterilization
presented with acute right lower abdominal pain and vomiting. Initial
ultrasound suggested a right ovarian hemorrhagic cyst, leading to a
preoperative diagnosis of cyst torsion. However, diagnostic laparoscopy
revealed a 6x4 cm gangrenous hydrosalpinx on the left with four complete
twists, and significant congestion in the right fallopian tube, while the right
ovary appeared normal. Surgical intervention included a left
salpingo-oophorectomy and right partial salpingectomy. Histopathological
examination confirmed the presence of a dermoid cyst in the left ovary and
extensive congestion in the fallopian tube. Isolated fallopian tube torsion is
exceedingly rare, with an estimated incidence of 1 in 1.5 million. This case
emphasizes the importance of including hydrosalpinx torsion in differential
diagnoses, particularly when clinical symptoms are inconsistent with
radiological findings. Accurate and timely diagnosis is critical for
appropriate management and to prevent potential complications.
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