Save the Tube in Isolated Paraovarian Cyst and Fallopian Tube Torsion: Nuances in Diagnosis and Minimally Invasive Surgery

Introduction: When a woman comes in the emergency with acute pain in lower abdomen and vomiting, adnexal torsion should be ruled out.The chances of isolated paraovarian cyst and fallopian tube torsion are very rare with an incidence of 1 in 1.5 million women.This case explores the nuances in its diagnosis and surgical management.Case presentation and discussion: This is a case of a para 1 woman, with acute abdomen and suspected case of ovarian torsion.However, on laparoscopy, isolated fallopian tube torsion (IFTT) with a paraovarian cyst was incidentally found.Detorsion and removal of the paraovarian cyst was done.As some reperfusion was observed, salpingectomy wasn't done.On follow-up, she had conceived spontaneously within six months of the surgery.Preoperative distinction between fallopian tube and ovarian torsion is very difficult.Radiological signs like the "Whirlpool sign" or the "Beads on a string sign" can be easily missed.The main surgical principles in laparoscopy include removal of the paraovarian cysts and salpingectomy in parous women with hematosalpinx or tubal rupture.However, in young women and in those who desire future pregnancy, tubes should be conserved, even if they look black or unviable. Conclusion and clinical significance:A high index of suspicion for adnexal torsion is essential in all reproductive age women with acute abdomen, vomiting and any adnexal mass.The final diagnosis of IFTT, which is very rare, is only confirmed during laparoscopy, after proper anatomical delineation.Decision regarding salpingectomy is a very crucial decision which depends on the age and fertility needs of the woman.The fallopian tube can be left behind, even if dark and unviable, as the maximum morbidity associated with leaving it would be a blocked tube in a few, thus giving some scope of pregnancy in the women.