Isolated Fallopian Tube Torsion: An Underdiagnosed Entity with Debatable Management

Study Objective: To study features of isolated fallopian tube torsion (IFTT) to promote early diagnosis of this entity and describe options for management. Design: Retrospective cohort study from October 2017 through October 2020. Setting: Tertiary care hospital. Patients: All patients with surgically confirmed adnexal torsion or IFTT during the study period. Interventions: All of the patients underwent gynecological examination, imaging, and laparoscopy. Measurements and Main Results: During this 3-year period, 64 patients underwent laparoscopy owing to confirmed torsion, of which 55 had adnexal torsion, and 9 had IFTT. Patients with IFTT tended to be younger (21.2 years ± 8.2 vs 29.1 years ± 11.9, p =.06) and had more fever on admission (p =.007). On ultrasound examination, isolated hydrosalpinx was demonstrated only in patients with IFTT (p <.001). During surgery, more para-ovarian cysts were observed in patients with IFTT (44.4% vs 10.9%, p =.01), whereas patients with adnexal torsion had more ovarian cysts (52.7% vs 0%, p =.003). The most common procedure was detorsion in both groups. Most patients that underwent detorsion of the tube had a normal ultrasound scan on follow-up examination. Conclusion: IFTT is probably underdiagnosed. Its clinical presentation is more equivocal than adnexal torsion, and ovaries are usually of normal size on ultrasonography. Hydrosalpinx or para-ovarian cysts should raise suspicion toward IFTT. Detorsion of the tube is probably a valid management option, although further research with long-term follow-up analyzing tubal patency is necessary to define the optimal management for this condition.