Twisted Right Fallopian Tube With a Large Fimbrial Cyst: A Diagnostic Challenge in Acute Pelvic Pain

Acute pelvic pain in women of reproductive age presents a diagnostic challenge, often mimicking surgical and gynecological emergencies such as appendicitis, ovarian torsion, or urolithiasis. Isolated torsion of the fallopian tube (IFTT) is a rare but important differential, with an incidence estimated at one in 1.5 million women. Fimbrial cysts are uncommon adnexal lesions that may predispose to torsion by increasing tubal mobility. We present a case of a 34-year-old woman, who presented to the emergency department with severe right iliac fossa pain, inconclusive preoperative imaging, and an intraoperative diagnosis of right fallopian tube torsion due to a large fimbrial cyst. Laparoscopic detorsion and cystectomy preserved tubal integrity. This case highlights the importance of early surgical intervention in suspected adnexal torsion to preserve fertility.