A Rare Case of Torsion of Hydrosalpinx Masquerading as Torsion of the Ovary

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 salpingooophorectomy 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.