Isolated Fallopian Tube Torsion: While Rare, Beware it\u27s There

ABSTRACT Isolated fallopian tube torsion (IFTT) is a rare fertility-threatening disorder. If left undiagnosed it can also become life-threatening. Awareness and timely recognition are key to caring for patients with this diagnosis. Unfortunately, this diagnosis is not well known by most emergency medicine physicians and is often misdiagnosed initially and discovered later in the operating room. A definitive diagnosis is difficult to make as the gold standard is direct visualization with laparoscopy. Ultrasound is a tool that can guide an emergency physician to this gynecological diagnosis. This case presents a female of childbearing age who presented for sudden onset, left lower abdominal pain. A transvaginal ultrasound demonstrated appropriate blood flow to the left ovary with an adjacent large tubular structure in the left adnexa. The patient was transferred to the gynecology service with our working diagnosis of hydrosalpinx versus tubo-ovarian abscess (TOA). A definitive diagnosis, made by the gynecologist intraoperatively, was IFTT showing an edematous and ischemic fallopian tube. There was no intraoperative evidence of TOA. A salpingectomy was performed as the fallopian tube was no longer viable and the patient had a full recovery. This case highlights the difficulty in making the diagnosis of IFTT and its lack of published case reports in the emergency medicine literature