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Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients
Beth Schwartz1, Nimali Weerasooriya2, Rebecca Mercier2
1Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
Insights
Isolated fallopian tube torsion (IFTT) presents similarly to adnexal torsion (AT) but often involves a paratubal cyst and preserved Doppler flow. Consider IFTT in pediatric patients with pain, nausea, and vomiting and an adnexal mass separate from the ovary.
Area of Science:
- Gynecology
- Pediatric Surgery
- Radiology
Background:
- Isolated fallopian tube torsion (IFTT) is a rare and challenging diagnosis within adnexal torsion (AT).
- Prompt diagnosis and treatment are crucial to prevent complications.
- This study aimed to identify clinical and radiologic predictors of IFTT in a pediatric population.
Purpose of the Study:
- To identify clinical and radiologic factors associated with surgically-confirmed IFTT.
- To compare these factors with those in patients without torsion and with AT.
- To evaluate the diagnostic accuracy of a composite score for predicting torsion.
Main Methods:
- Retrospective chart review of pediatric patients undergoing surgery for suspected adnexal torsion (2016-2019).
- Intraoperative confirmation of torsion; IFTT defined as isolated tubal torsion, AT as ovarian torsion.
- Comparison of clinical and radiologic variables, including a vomiting and adnexal volume composite score (VVCS).
Main Results:
- Of 168 torsion cases, 33 were IFTT and 135 were AT.
- IFTT patients were younger, more likely to be premenarchal, and presented with more nausea and vomiting.
- IFTT was associated with paratubal cysts and larger adnexal volumes compared to non-torsion and AT groups; VVCS accuracy was 83.9% for IFTT.
Conclusions:
- IFTT shares clinical similarities with AT but is distinguished by a higher incidence of paratubal cysts and preserved Doppler flow.
- Strong consideration of IFTT is warranted in pediatric patients presenting with pain, nausea, and vomiting, and an imaging-identified adnexal mass separate from the ovary.
- These findings aid in earlier diagnosis and appropriate management of IFTT.
Background:
Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population.
Methods:
We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient.
Results:
Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%.
Conclusions:
IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow.
Level Of Evidence:
Level II.
Type Of Study:
Prognosis study.
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