Adnexal Torsion Secondary to Primary Cystadenoma of the Fallopian tube

Abstract

Background: Ovarian torsion is twisting of the ovary, typically due to an ovarian mass. However, rare primary fallopian tube tumors can be in the differential. Symptoms can occur intermittently as the adnexal mass torses and de-torses. Prompt diagnosis is crucial for the preservation of ovarian functionality and fertility. Case Description: Pt. is an 18 yo. who presented to the ED four times over the course of 6 months with repeated episodes of severe LLQ abdominal pain. During each evaluation, CTAP showed bilateral cysts, however, concurrent ovarian dopplers were negative for ovarian torsion. Gynecologists were consulted and based upon clinical exam; outpatient follow up was recommended. A follow up outpatient MRI had new concerning changes for a compromised ovary in comparison to prior imaging, so the patient was immediately contacted for counseling and recommended surgical management. Intraoperative findings revealed a twisted enlarged necrotic mass primary within the fallopian tube with normal ovaries bilaterally. Left ovarian detorsion and salpingectomy were performed with bilateral ovarian preservation. Pathology was consistent with serous cystadenoma within the left fallopian tube. Clinical Significance: This case highlights difficulties in diagnosing gynecological pathology in a patient with intermittent symptoms and varying presentation on imaging. Torsion was not due to an ovarian mass, but rather a rarer primary cystadenoma of the fallopian tube. Surgical intervention was successful in detorsion, salpingectomy of the affected tube, and preserving the ovary in order to decrease cardiovascular and osteoporotic risks and increase fertility options. Conclusion: Ovarian torsion represents a surgical emergency that requires prompt diagnosis. This case was complicated by rarer torsion due to a fallopian tube mass and inconsistent imaging findings. MRI findings lead to necessary laparoscopy for ovary detorsion and preservation.