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

Evaluation and Treatment

A medical history of ovarian or fallopian tube disease, along with the symptoms described above, is an important consideration. The available laboratory or imaging studies cannot confirm fallopian tube torsion. They can, however, rule out other abdominal conditions with similar clinical characteristics, such as nephrolithiasis, cholelithiasis, appendicitis, extrauterine pregnancy, tubo-ovarian abscess, and pancreatitis. In our center, patients with a differential diagnosis of fallopian tube torsion routinely undergo a complete physical and vaginal examination, color Doppler transvaginal sonography (Figure 1), and other imaging and laboratory studies (abdominal sonography or radiographs, intravenous pyelography, complete blood count, serum amylase and liver enzyme measurements, and so on). The finding of high impedance or absence of flow in a tubular structure, especially in a patient with a history of tubal ligation, can be indicative of the diagnosis.[24,25] Before laparotomy, culdocentesis had been suggested to determine whether there was intraperitoneal bleeding. This technique has been replaced by laparoscopy, which is currently the most specific diagnostic tool for evaluating torsion. The definitive diagnosis of tubal torsion is still made retrospectively, usually after diagnostic laparoscopy.

Normal adnexal blood flow, displayed by color Doppler transvaginal ultrasonography. Red indicates flow toward the transducer, and blue, away from it. The Doppler pattern can differentiate between arterial and venous flow by the pulsation pattern (continuous nonpulsative flow indicates a venous flow). Absence of flow, in addition to the clinical symptoms, raises the possibility of adnexal torsion.

At the present time, laparoscopic adnexal detorsion, not adnexectomy, is the procedure of choice. Because most of the patients are in their reproductive years, efforts should be made to preserve fertility if the ischemic damage appears to be reversible, and no malignancy is suspected., A complete resection is performed when the tissue is gangrenous, there is a tubal or ovarian neoplasm, or the woman has completed her family. When there is no apparent ischemic damage, most of the twisted adnexa regain their function.

Recovery is much faster after laparoscopy than after laparotomy. Laparoscopy also causes fewer pelvic adhesions, which is especially important for women of reproductive age who wish to preserve their fertility. Compared with laparotomy, laparoscopy (especially if performed in the second trimester) provides a better chance for the successful continuation of a pregnancy. If the patient is in her third trimester, most surgeons prefer laparotomy, because laparoscopy is technically very difficult. The main complications associated with the operation are from the effects of general anesthesia, bleeding, perforation of hollow viscera or blood vessels, infection, herniation from the trocar entry port, abortion, or preterm delivery.

We would like to emphasize that most of the studies are case reports of laparotomy and adnexectomy, many of them without histologic confirmation. Further research is needed regarding some of the unanswered questions about the percentage of the preserved tubes that progress to gangrene, future fertility, and pregnancy outcome.


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