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Background Isolated fallopian tube torsion is a rare but critical gynecologic emergency that often presents a diagnostic challenge owing to its nonspecific symptoms and infrequent occurrence. Case presentation This paper discusses the case of a 37-year-old Saudi female who was hospitalized with acute right lower quadrant pain, accompanied by nausea and vomiting. The initial differential diagnosis included ovarian torsion and appendicitis. Diagnostic laparoscopy revealed a right fallopian tube twisted five times, which was later confirmed to be necrotic. Given the irreversible damage to the fallopian tube, a right salpingectomy was performed. The patient recovered well postoperatively and was discharged after 48 h without complications. Conclusion This case report underscores the importance of considering isolated fallopian tube torsion in the differential diagnosis of acute abdominal pain and highlights the need for prompt surgical intervention to prevent severe complications. The rarity of isolated tubal torsion, normal Doppler findings despite significant torsion, and the surgical management decisions impacting fertility make this case an informative addition to current literature.

PurposeIsolated fallopian tube torsion (IFTT) is defined by rotation of the fallopian tube around itself without involving the ipsilateral ovary. It is a rare cause of acute lower abdominal pain in (adolescent) girls, but is commonly overlooked. Due to its rarity, literature is still scarce. Currently there is no generally accepted management and treatment.MethodsA retrospective analysis of all IFTT cases treated in our institution was performed. In addition, a systematic literature research on pediatric IFTT was carried out on Medline/ PubMed database according to PRISMA principles using predefined search terms and inclusion criteria. Patient characteristics regarding age, clinical symptoms, diagnostic methods, treatment, and follow-up were analyzed.ResultsThree of our patients and fifty-nine reports totaling one hundred seventy girls were included in the analysis. Mean age was 13.0 years. Left tube was slightly more often affected (52.9%). Abdominal pain was present in 99.4% of cases accompanied with nausea in 57.1%. In only 16.4%, correct preoperative diagnosis was made. Salpingectomy was the most common treatment in 111 (66.9%) cases, 55 (33.1%) patients were treated with detorsion of the tube (organ-sparing management). Girls with symptoms longer than 1 day had a significant higher rate of salpingectomy (95% CI, P = 0.0323).ConclusionWhen IFTT is suspected, emergency laparoscopy should be performed to possibly preserve future reproductive potential. In case of detorsion and reinstated blood supply, organ-preserving management should be performed with simultaneous addressment of concomitant pathology if possible. Sufficient long-term follow-up must be assured to get significant results to introduce guidelines for children and adolescents.

Background The endometrioma accompanying hydrosalpinx can affect the success rate of in vitro fertilization (IVF). We aimed to determine the incidence of hydrosalpinx in infertile patients with endometrioma and its effects on in vitro fertilization success. Methods In our retrospective study, we performed hysterosalpingography (HSG) on patients diagnosed with endometrioma through ultrasound evaluation. Then, we performed diagnostic laparoscopy on patients with suspected tubal pathology and/or hydrosalpinx after HSG assessment. Laparoscopic tubal occlusion was performed for patients with hydrosalpinx. Results HSG was performed on 760 patients diagnosed with ovarian endometriosis. After the assessment of HSG images, hydrosalpinx was detected in 184 of 760 patients (24.2%) and diagnostic laparoscopy was performed. Unilateral or bilateral hydrosalpinx were detected at 65 of 184 (35.3%) patients. Laparoscopy and proximal tubal occlusion were performed in these patients. Incidence of hydrosalpinx was found to be 8.5% in IVF patients with ovarian endometrioma. Conclusion Tubal patency screening may be considered for the patients with endometrioma before embryo transfer to prevent IVF failure due to hydrosalpinx.

Introduction Diverticulitis can be complicated by fistulas between the colon and neighboring structures, which predispose to significant morbidity and mortality. Fistulas involving the female urogenital tract often present with urogynecologic symptoms, such as vaginal discharge or recurrent urinary tract infections. While colo-vaginal fistulas, a more common variant, often present with vaginal flatulence, colo-salpingeal fistulas are exceedingly rare and have not been reported with this symptomatology. We describe a case of colo-saplingeal fistula presenting with vaginal flatulence, requiring multidisciplinary collaboration for diagnosis and management. Case A 63-year-old woman presented with vaginal flatulence in the setting of persistent diverticulitis. Computed tomography (CT) scan revealed sigmoid diverticulitis, a submucosal abscess abutting the uterus, and air within the endometrial cavity, raising suspicion for a colo-uterine fistula. Following transient symptomatic relief with medical management and antibiotics, recurrence of symptoms prompted surgical intervention. Laparoscopic exploration allowed diagnosis of the colo-salpingeal fistula. Sigmoid colectomy and left salpingo-oophorectomy were performed with a minimally invasive surgical approach, resulting in an uncomplicated recovery with remission of symptoms. Discussion This rare case highlights novel gynecologic symptoms for a colo-salpingeal fistula, contrasted with reported presentations through a comprehensive literature review. This case underscores the importance of recognizing gynecologic symptoms related to diverticular disease, which may be subtle, but provide important considerations for prognosis and treatment. A multidisciplinary approach to care from diagnosis through surgery allowed for successful recognition and minimally invasive treatment of this anomalous condition before further complications could arise. Ultimately, surgical approaches to diverticulitis-associated gynecologic fistulas should be individualized.

Isolated fallopian tube torsion (IFTT) is a rare but important gynaecological emergency requiring prompt diagnosis and treatment to prevent ischaemic damage of the fallopian tube and to preserve fertility, particularly in young women. Misdiagnosis or delayed treatment can have significant fertility consequences. Due to vague clinical signs, IFTT is often overlooked. IFTT can be caused by a paratubal cyst, which is a rare but clinically significant condition.We report a case of an adolescent girl with acute sharp right lower abdominal pain and vomiting. Laparoscopy revealed a right fallopian tube torsion caused by a 10 cm paratubal cyst, which was successfully removed without damaging the fallopian tube after confirming revascularisation of the fallopian tube.

Abstract Isolated torsion of a hydrosalpinx is an exceptionally rare gynaecological emergency that often presents with vague and non-specific symptoms, leading to delays in diagnosis. Hydrosalpinx is a known predisposing factor for tubal torsion, yet isolated involvement without ovarian pathology is uncommon. We report the case of a 22-year-old woman presenting with acute right lower abdominal pain and vomiting, in whom ultrasonography demonstrated a cystic adnexal lesion distinct from the ovary. Laparoscopic evaluation confirmed isolated torsion of the right hydrosalpinx with necrosis, necessitating salpingectomy. Early laparoscopic intervention enabled prompt recovery and preservation of ovarian function. This case highlights the importance of maintaining a high index of suspicion for isolated tubal torsion in reproductive-aged women presenting with acute pelvic pain.

Background Approximately 50% of isolated fallopian tube torsion cases and 5%-10% of tubo-ovarian torsion cases involve an ipsilateral paraovarian cyst. This study aimed to describe the clinical features of paraovarian cyst torsion including isolated fallopian tube torsion and tubo-ovarian torsion and to identify factors associated with delayed surgical intervention. Methods In this retrospective cohort study, we included adult women with surgically confirmed adnexal torsion and a coexisting ipsilateral paraovarian cyst at Peking University Third Hospital between January 2012 and December 2024. Group differences were analysed using independent samples t-tests, Mann–Whitney U tests and chi-square or Fisher’s exact tests. Multiple comparisons of clinical features were adjusted using the Benjamini–Hochberg method with a pre-specified false discovery rate threshold of 0.10. Logistic regression was performed to identify factors associated with a surgical decision-making interval exceeding 12 h after emergency department presentation. Results This study included 142 patients, with 66.2% diagnosed with isolated fallopian tube torsion and 33.8% with tubo-ovarian torsion. The mean diameter of paraovarian cysts was significantly larger in the tubo-ovarian torsion group than in the isolated fallopian tube torsion group (7.4 [5.9, 9.4] vs. 5.3 [4.4, 6.2] cm, q < 0.001). Among patients presenting with acute abdominal pain, the tubo-ovarian torsion group had a higher incidence of identifiable precipitating factors (OR = 3.61, 95%CI: 1.48–8.82, q = 0.040). This group also showed a trend toward a higher incidence of abdominal tenderness (OR = 2.33, 95% CI: 1.01–5.39, q = 0.075) and gastrointestinal symptoms such as nausea and/or vomiting (q = 0.060). However, no significant differences were observed in other pain-related characteristics, including pain severity and radiation patterns. Delayed surgical decision-making (> 12 h) occurred at more than 2.4 times the rate in the isolated fallopian tube torsion group (31.5% vs. 13.0%), though this association was of borderline statistical significance (q = 0.060). Logistic regression identified a paraovarian cyst diameter ≤ 6 cm, along with white blood cell count less than 10 × 10 9 /L, as independent factors associated with surgical decision-making duration exceeding 12 h. Conclusions Patients with isolated fallopian tube torsion complicating a paraovarian cyst typically present with smaller cysts and subtler clinical manifestations. Smaller paraovarian cyst diameter and lower white blood cell count were associated with delayed surgical intervention.

Purpose To identify clinical, sonographic, and laboratory characteristics that distinguish between tubal rupture and tubal abortion following methotrexate (MTX) treatment for ectopic pregnancy (EP) and to compare the morbidity associated with these 2 outcomes. Methods This retrospective cohort study included women treated with MTX for EP at Galilee Medical Center between 2012 and 2024. Data on clinical presentation, ultrasound findings, and laboratory values were analyzed. Uregint surgical interventions were classified as tubal rupture or tubal abortion based on intraoperative findings. A comparative analysis between these groups was performed, and multivariable modeling was used to identify predictors of tubal rupture. Results Among 280 women treated with MTX, 47 (16.7%) required urgent surgical intervention. Of these, 15 (34.9%) were confirmed as tubal rupture, while 28 (65.1%) were tubal abortion. Women with tubal rupture more frequently presented with free pelvic fluid on transvaginal ultrasound (64.3 vs. 28.6%,  P  = 0.045) and had significantly higher intraoperative blood loss (433 ± 143 mL vs. 250 ± 201 mL,  P  = 0.001). A multivariable logistic regression model identified free pelvic fluid as an independent predictor of tubal rupture (odds ratio: 6.09, 95% CI 1.23–30.09, P  = 0.027). No significant differences in preoperative beta-hCG levels or other clinical symptoms were observed between the groups. Conclusion Tubal rupture and tubal abortion share overlapping clinical features, making differentiation with current diagnostic tools challenging. Free pelvic fluid on ultrasound is a significant indicator of tubal rupture, underscoring the importance of timely surgical intervention. Recognizing that tubal abortion may be a self-limiting condition in some cases offers opportunities to preserve fallopian tube integrity and reduce unnecessary surgeries. Further research is needed to improve diagnostic accuracy and explore conservative management strategies for tubal abortion. Date and number of trial registration: December 2024, 0138–24-NHR.

Background Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of thyroid tissue, accounting for approximately 1% of all ovarian tumors (J Clin Diagn Res 8:FD03–4, 2014, Pathology 39:139–46, 2007). Its nonspecific clinical presentation often complicates preoperative diagnosis. Case Presentation A 48-year-old woman with diabetes mellitus presented with acute lower abdominal pain and fever. Imaging suggested bilateral tubo-ovarian abscesses(TOAs). Emergency laparoscopy confirmed bilateral TOAs and revealed a distinct right ovarian cystic mass. Right salpingo-oophorectomy and left salpingostomy were performed. Histopathology identified struma ovarii in the right ovary. Postoperative thyroid function was normal, and the patient remained asymptomatic with no recurrence at six-month follow-up. Conclusion This case highlights (reviewer 1 comment 7) the rare coexistence of struma ovarii and bilateral TOAs, emphasizing the importance of considering uncommon pathological entities when evaluating complex adnexal masses, particularly in acute infectious settings.