A rare case of right lower quadrant abdominal pain

Isolated fallopian tube torsion without involvement of the ovary is a rare condition most frequently presenting during reproductive years. Imaging, vitals, physical exam, and laboratory findings all fail to help establish a definitive diagnosis. The majority of the diagnoses are made on the operating table. Physical exam most often reveals unilateral and localized abdominal pain, often with nausea and vomiting, but few other reliably common findings. Diagnosis becomes even more challenging due to the fact that isolated tubal torsion occurs often in pregnancy and preferentially on the right, further complicating the clinical picture. We describe a case of isolated tubal torsion, unique in that localized necrosis and inflammation from the torsion triggered a secondary appendicitis. The patient required surgical intervention, and an appendectomy and salpingectomy emergently. Given its elusive and rare nature, awareness and early intervention is required by the emergency physician to recognize tubal torsion, as operative intervention is crucial, and can lead to preservation of fertility and improved fetal survival.