Fallopian tube torsion is a rare gynecology problem which causes significant acute abdominal pain in female. It was first reported in 1890 by Bland–Sutton. Its prevalence was reported to be 1 in 1.5 million women [1]. Patients with this condition may present with nausea and vomiting, which is associated with acute abdominal pain and peritonitis. Differential diagnosis can be twisted ovarian cyst, ectopic pregnancy, pelvic inflammatory disease, appendicitis, urolithiasis, cystitis but rarely torsion of fallopian tube.

We report a case of a 16-year-old non-sexually active girl, presented to the emergency department with four days history of suprapubic pain, which radiated to the right iliac fossa, on 14th day of her menstrual cycle. The pain was associated with diarrhea and fever two days prior. Her menstruation was otherwise normal. She denied of having any medical or surgical illness before.

Examination revealed a tender right iliac fossa with positive rebound tenderness. No mass was noted. Perineum examination was negative for any swelling or abnormal discharge. There was tenderness at the right adnexa. She was referred to the surgical department where she was further investigated.

Total white blood cells count of the patient was 16x109/dl. Her urine beta-hCG was negative. Ultrasound of the abdomen revealed an anteverted uterus measuring 7x5 cm, with an intrauterine fluid collection measuring 1.8x2 cm. A complex right adnexal mass of 8x7 cm was found.

A diagnosis of acute appendicitis was made. A laparoscopic surgery was performed. Intraoperatively, the appendix was found normal. An on-table referral to gynecology team was made with the finding of twisted right fallopian tube with fulcrum of torsion at the isthmus (Figure 1). No area of gangrene was seen. The left fallopian tube, bilateral ovaries and uterus were normal. The twisted tube was untwisted (Figure 2). The length of the fallopian tube was 13 cm.

Antibiotics which comprise metronidazole and doxycycline were given for two weeks. Postoperative period was uneventful and the patient was discharged home on the third day.

Fallopian tube torsion is a rare gynecology problem which causes significant acute abdominal pain in female. It was first reported in 1890 by Bland–Sutton. Its prevalence was reported to be 1 in 1.5 million women [1]. Patients with this condition may present with nausea and vomiting, which is associated with acute abdominal pain and peritonitis. Differential diagnosis can be twisted ovarian cyst, ectopic pregnancy, pelvic inflammatory disease, appendicitis, urolithiasis and cystitis [2].

The aetiology is uncertain. Many aetiologies of fallopian tube torsion have been suggested. They are divided into intrinsic and extrinsic factors. Intrinsic factors including hydrosalpinx, tubal carcinoma or prior tubal ligation whereas extrinsic factors including adhesions, pregnancy, mechanical factors, movement or trauma to the pelvic organs or pelvic congestion [3][4]. Although torsion of fallopian tube has been frequently reported, isolated torsion of a normal tube is very unusual. This case was the first to be encountered in our center for both types of torsion. The rare occurrence of this condition, together with the presence of clinical symptoms which mimics acute appendicitis and a slightly raise in the total white cell count had make the patient to be referred to the surgical team rather than gynecology team. In addition, it was fortunate for the patient to have undergone a surgical intervention for acute appendicitis or the diagnosis of torsion tube will be missed and the tube will be gangrenous and beyond repair. The possible aetiology for this case is a rather long tube.

The mainstay treatment for torsion tube remains tubal detorsion and preservation of the tube, unless the tube is totally necrotic [3]. Salvage of the tube to preserve fertility, especially in this young nulliparous lady, is crucial. However, the patient is at risk to get an ectopic pregnancy later in life if the tubal function has been compromised. Recurrence of tubal torsion has also been reported [4]. In such case, the tubal function is high likely to be compromised, thus salvaging the tube may not be beneficial [5].

Although torsion of the fallopian tube is a rare entity, it should be considered in a female who presented with acute abdominal pain.

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