Unilateral isolated fallopian tube torsion: a rare case report from Syria

Importance and introduction: Fallopian tube torsion is a rare gynecologic emergency that often mimics other causes of acute abdominal or adnexal pain. Its diagnosis is challenging because symptoms and imaging findings are typically nonspecific, especially in women with previous pelvic surgery or tubal ligation. Case presentation: A 41-year-old G5P5 woman presented with a 4-day history of intestinal ileus, nausea, vomiting, fever, chills, and abdominal discomfort. Her history included two cesarean sections with a Pomeroy tubal ligation. Examination showed dehydration, left iliac tenderness, and an enlarged, painful uterus. Laboratory tests revealed elevated WBC (11.9 × 10 3 /µL), C-reactive protein (91 mg/dL), and estimated sedimentation rate (55 mm/h). Ultrasound detected a complex left adnexal mass consisting of a 63-mm cystic component and a 58-mm mixed-echogenic component. CT showed minimal pelvic free fluid and parauterine fat stranding. Due to worsening symptoms, laparotomy was performed, revealing a completely necrotic left fallopian tube twisted five times and a normal contralateral tube. Bilateral salpingectomy and appendectomy were performed. Histopathology confirmed hemorrhagic infarction with no malignancy. The patient recovered well. Clinical discussion: This case illustrates the diagnostic difficulty of isolated tubal torsion, which may be influenced by prior tubal surgery and altered pelvic anatomy. Imaging can suggest adnexal pathology but is rarely definitive. Conclusion: Clinicians should consider fallopian tube torsion in women with acute unilateral pelvic pain and adnexal masses, as timely surgery is essential to prevent irreversible ischemia.