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Isolated Tubal Torsion With Endometriosis
Images in Gynecological Surgery
Isolated Tubal Torsion With Endometriosis Chin-Jung Wang, MD*, Justina Go, MD, and Yu-Cheng Liu, MD From the Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan (Drs. Wang and Liu), and Department of Obstetrics and Gynecology, Chinese General Hospital and Medical Center, Manila, Philippines (Dr. Go).
A 34-year-old woman, gravida 1, para 1, consulted our department because of secondary infertility of 1-year duration. On transvaginal ultrasound, a unilocular hypoechoic cystic mass was observed in the left adnexa measuring 6.70 ! 5.56 cm, suggestive of a paratubal cyst (Fig. 1). She menstruated regularly with dysmenorrhea at a numeric rating scale of 5. She delivered her child vaginally with no other previous operations and pelvic inflammatory disease. Laboratory examination showed her cancer antigen-125 level at 29.6 U/mL. On laparoscopy, there was torsion of the left fallopian tube, twisting around itself 4 times, with its distal end engorged (Fig. 2) containing chocolatelike fluid and adhered to the peritoneum and cul-de-sac. The uterus, right adnexa, and left ovary were grossly normal. Adhesiolysis and left partial salpingectomy were performed. Histopathologic findings revealed tubal endometrioma with hemosiderinladen macrophages, fibrosis, and chronic inflammation.
The authors declare no conflicts of interest. Corresponding author: Chin-Jung Wang, MD, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. E-mail: [email protected] Submitted June 26, 2016. Accepted for publication July 1, 2016. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2016 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2016.07.002
The etiology of fallopian tube torsion remains to be an enigma. Predisposing factors include excessive length and tortuosity of the tube, hydrosalpinx, hematosalpinx and pyosalpinx, previous sterilization, abnormal peristalsis, and endometriosis. In questionable adnexal cystic masses noted on ultrasound, laparoscopy should be performed immediately to minimize the extent of necrosis in cases of fallopian tube torsion [1–4]. References 1. Comerci G, Colombo FM, Stefanetti M, Grazia G. Isolated fallopian tube torsion: a rare but important event for women of reproductive age. Fertil Steril. 2008;90:1198.e23–1198.e25. 2. Youssef AF, Fayad MM, Shafeek MA. Torsion of the fallopian tube. A clinic-pathological study. Acta Obstet Gynecol Scand. 1962;41:292–309. 3. Phillips K, Fino ME, Kump L, Berkeley A. Chronic isolated fallopian tube torsion. Fertil Steril. 2009;92:394.e1–394.e3. 4. Wenger JM, Soave I, Lo Monte G, Petignat P, Marci R. Tubal endometrioma within a twisted fallopian tube: a clinically complex diagnosis. J Pediatr Adolesc Gynecol. 2013;26:e1–e4.
Journal of Minimally Invasive Gynecology, Vol -, No -, -/- 2016
2
Fig. 1 Ultrasound findings of the left adnexa.
Fig. 2 Torsion of the left fallopian tube with its distal end engorged; normal left ovary.
Isolated Tubal Torsion With Endometriosis Chin-Jung Wang, MD*, Justina Go, MD, and Yu-Cheng Liu, MD From the Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan (Drs. Wang and Liu), and Department of Obstetrics and Gynecology, Chinese General Hospital and Medical Center, Manila, Philippines (Dr. Go).
A 34-year-old woman, gravida 1, para 1, consulted our department because of secondary infertility of 1-year duration. On transvaginal ultrasound, a unilocular hypoechoic cystic mass was observed in the left adnexa measuring 6.70 ! 5.56 cm, suggestive of a paratubal cyst (Fig. 1). She menstruated regularly with dysmenorrhea at a numeric rating scale of 5. She delivered her child vaginally with no other previous operations and pelvic inflammatory disease. Laboratory examination showed her cancer antigen-125 level at 29.6 U/mL. On laparoscopy, there was torsion of the left fallopian tube, twisting around itself 4 times, with its distal end engorged (Fig. 2) containing chocolatelike fluid and adhered to the peritoneum and cul-de-sac. The uterus, right adnexa, and left ovary were grossly normal. Adhesiolysis and left partial salpingectomy were performed. Histopathologic findings revealed tubal endometrioma with hemosiderinladen macrophages, fibrosis, and chronic inflammation.
The authors declare no conflicts of interest. Corresponding author: Chin-Jung Wang, MD, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. E-mail: [email protected] Submitted June 26, 2016. Accepted for publication July 1, 2016. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2016 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2016.07.002
The etiology of fallopian tube torsion remains to be an enigma. Predisposing factors include excessive length and tortuosity of the tube, hydrosalpinx, hematosalpinx and pyosalpinx, previous sterilization, abnormal peristalsis, and endometriosis. In questionable adnexal cystic masses noted on ultrasound, laparoscopy should be performed immediately to minimize the extent of necrosis in cases of fallopian tube torsion [1–4]. References 1. Comerci G, Colombo FM, Stefanetti M, Grazia G. Isolated fallopian tube torsion: a rare but important event for women of reproductive age. Fertil Steril. 2008;90:1198.e23–1198.e25. 2. Youssef AF, Fayad MM, Shafeek MA. Torsion of the fallopian tube. A clinic-pathological study. Acta Obstet Gynecol Scand. 1962;41:292–309. 3. Phillips K, Fino ME, Kump L, Berkeley A. Chronic isolated fallopian tube torsion. Fertil Steril. 2009;92:394.e1–394.e3. 4. Wenger JM, Soave I, Lo Monte G, Petignat P, Marci R. Tubal endometrioma within a twisted fallopian tube: a clinically complex diagnosis. J Pediatr Adolesc Gynecol. 2013;26:e1–e4.
Journal of Minimally Invasive Gynecology, Vol -, No -, -/- 2016
2
Fig. 1 Ultrasound findings of the left adnexa.
Fig. 2 Torsion of the left fallopian tube with its distal end engorged; normal left ovary.