Purpose or Case Report: Fallopian tube torsion is a rare cause of acute abdominal pain in pediatric patients. Pelvic ultrasound is the first imaging modality utilized to evaluate for pelvic pathology, typically to rule out ovarian torsion. Ultrasound findings of fallopian tube torsion can be challenging, leading to delayed surgical intervention, particularly when ovaries have a normal gray scale appearance and spectral Doppler waveforms. We reviewed the ultrasound features of fallopian tube torsion in a series of surgically proven cases.
Methods & Materials: In this IRB approved retrospective study, patients who underwent pelvic ultrasound because of abdominal or pelvic pain between 2005 and 2015 were identified. Ten patients aged between 10 and 16 were found to have surgical evidence of tubal torsion. Clinical data and imaging features were analyzed.
Results: All patients presented with one or more episodes of abdominal pain, the interval between initial presentation and surgery ranging between 1 day and 2 months. All 10 patients underwent transabdominal ultrasound examinations while 3 patients also had CT exams. Diagnosis of fallopian tube torsion and/or hydrosalpinx was suggested prospectively in 4 patients based on the presence of a tubular fluid filled adnexal structure on ultrasound. In the remainder 6 patients, the presence of large cystic midline structures arising from the adnexa was described. In these cases, concern for possible intermittent ovarian torsion or adnexal mass was raised despite the normal appearance of the ovaries. In two of these cases, a dilated fallopian tube was also present in retrospect. Necrotic fallopian tube changes leading to salpingectomy were found at surgery in 8 out of 10 cases. In 6 out of 10 cases associated paratubal cysts were noted, and in one case ovarian torsion was also present.
Conclusions: Delayed diagnosis in fallopian tube torsion can lead to salpingectomy with important implications on the future reproductive potential. In our retrospective review of ultrasound findings, the diagnosis was suggested prospectively only when hydrosalpinx was identified. A large cystic adnexal or midline pelvic mass with normal ovaries in a patient with pelvic pain should also raise concern for fallopian tube torsion. Increased awareness of these findings can lead to improved, timely diagnosis and prompt surgical intervention.