Laparoscopic Management of Isolated Fallopian Tube Torsion in Pregnancy

Isolated fallopian tube torsion (IFTT) is a rare gynecologic emergency that poses a diagnostic challenge during pregnancy due to its nonspecific clinical presentation and overlap with more common abdominal pathologies such as ovarian torsion and appendicitis. We report the case of a 20-year-old primigravid woman at 28 weeks gestation who presented with acute right lower quadrant pain. Diagnostic laparoscopy revealed a necrotic, torsed right fallopian tube associated with a paratubal cyst. We also reviewed the current literature on laparoscopic management of IFTT.

A systematic review following PRISMA guidelines identified seven additional cases of laparoscopic management of IFTT in the second or third trimester, yielding eight cases for analysis.

The mean maternal age was 28 years (18-36 years), and the average gestational age was 29 weeks (24-35 weeks). Right-sided abdominal pain was present in 100% of cases, with acute onset in 87.5% and associated nausea and vomiting in 75%. Ultrasonographic imaging consistently identified a pelvic mass with preserved ovarian Doppler flow; MRI was utilized in 75% of cases. The most common preoperative diagnosis was ovarian torsion (62.5%). Entry techniques included Palmer's point (42.9%), Lee-Huang point (42.9%), and one case utilizing umbilical-entry. Salpingectomy was performed in 87.5% of patients due to tubal necrosis. All reported pregnancy outcomes progressed to term.

This case and review support laparoscopy as a safe and effective management strategy for IFTT in the second and third trimesters, offering favorable maternal and fetal outcomes when performed with appropriate surgical technique and multidisciplinary coordination.