Fallopian Tube Torsion: Laparoscopic Evaluation and Treatment of a Rare Gynecological Entity

Haim Krissi, MD, Josef Shalev, MD, Itai Bar-Hava, MD, Rami Langer, MD, Arie Herman, MD, and Boris Kaplan, MD, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

J Am Board Fam Med. 2001;14(4) 

In This Article

Etiology

The exact cause of fallopian tube torsion is unknown. Some studies have postulated theoretical explanations. Torsion is unlikely with an intact tube and is more often the result of an ovarian cyst or tumor. Regad[2] surveyed 201 cases of fallopian tube torsion and found a normal appearance in only 24%. In many of the patients, no pathologic reports were available. Hydrosalpinx was found in 18%, and infection in 13%. Pelvic tumor and normal or ectopic pregnancy were reported in the remainder. It is noteworthy that in 12% of these cases, the diagnosis of fallopian tube torsion was made during a normal intrauterine pregnancy. Since Regad's report, 14 additional cases of tubal torsion during pregnancy have been described.[3,4,5] Fallopian tube torsion has also been described after surgical sterilization (mainly with the use of the Pomeroy technique[6,7,8,9,10]), in primary carcinoma of the fallopian tube,[11] with hematosalpinx,[12] during labor,[13] and in a premenarchal girl with endometriosis.[14]

Youssef et al[15] noted factors that could possibly influence the occurrence of fallopian tube torsion and divided them into two types: internal and external (Table 1). Taken together, the existing reports indicate that the mechanism underlying tubal torsion is apparently a sequential mechanical event.[16] The process begins with the mechanical blockage of the adnexal veins and lymphatic vessels by ovarian tumor, pregnancy, hydrosalpinx and pelvic adhesions after tubal infection, or pelvic operation. This obstruction causes pelvic congestion and local edema, with subsequent enlargement of the adnexa, which in turn induces partial or complete torsion (Table 2). Furthermore, the mechanical blockage of the distal part of the fallopian tubes, together with the normal secretion of the fallopian tube glands, can cause hydrosalpinx, a risk factor by itself for torsion.

The incidence of fallopian tube torsion is unknown, and only sporadic cases are reported each year. It rarely occurs before menarche or during menopause.[17,18,19,20] This dispersion of frequencies apparently is because most risk factors for tubal torsion, such as ovarian cysts, infections, and pelvic surgery, occur mainly in the reproductive age-group.

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