An unexpected twist: Isolated fallopian tube torsion in a term nulliparous patient

Introduction: Isolated fallopian tube torsion (IFTT) is the rotation of a fallopian tube without involvement of the ovary or adjacent vascular structures. It is a profoundly rare gynecologic emergency. Diagnosis is challenging because presenting symptoms and imaging findings are nonspecific and may be even more challenging during pregnancy due to the gravid uterus and attributing the pain to an obstetrical origin. Case Report: We describe a case of a 20-year-old G1P0 patient who presented at 36 weeks and 6 days of gestation with acute right lower quadrant abdominal pain. Abdominal ultrasound was non-diagnostic, and abdominal magnetic resonance imaging demonstrated a nonspecific loculated fluid in the right lower quadrant. Fetal status was reactive and reassuring. Due to persistence of the pain despite administration of opioids and high levels of suspicion for adnexal torsion, the patient had a primary cesarean section and pelvic exploration that revealed a purple-black, edematous, necrotic right hydrosalpinx twisted more than six times. The patient had a concurrent salpingectomy. She was discharged from the hospital on postoperative day 2 with a healthy newborn. Conclusion: This case highlights the importance of maintaining a high index of suspicion for IFTT in pregnant patients with severe, narcotic-refractory abdominal pain. Early recognition and prompt intervention are critical to optimize pregnancy outcomes.