title: Clinical manifestations in women with isolated fallopian tubal torsion; a rare but important entity.
abstract: BACKGROUND
  The diagnosis of adnexal torsion can be difficult to make, especially in isolated fallopian tube torsion (FTT). Only small series and several case reports on isolated FTT have been published in the literature.
  
  
  OBJECTIVE
  To demonstrate symptom presentations, objective findings and surgical outcomes in women with isolated FTT over a 12-year period at a tertiary hospital.
  
  
  METHODS
  Using the International Classification of Disease, Ninth Revision, and Clinical Modification, we reviewed the clinical records of women with isolated FTT during 1996 and 2008 at our institute.
  
  
  RESULTS
  Seventeen women, age 13-50 (mean 32) with surgically proven isolated FTT, were included. Five women (29.4%) had tubal ligation history. None of these cases were diagnosed before operation. Pain characteristics were variable; the onset was sudden in 10 (58.8%) and 17 (100%) complained of lower abdominal pain, but only six (35.3%) had peritoneal signs. Other clinical manifestations were as follows: nausea or vomiting in seven women (41.2%), lower urinary tract symptoms in four (23.5%) and fever in three (17.6%). All the women had a cystic adnexal mass on ultrasound. An enlarged tubal mass (5-14 cm) was found in all the cases at surgery. Eleven women (64.7%) underwent laparoscopy, and six (35.3%) laparotomy for salpingectomy.
  
  
  CONCLUSIONS
  The diagnosis of isolated FTT is often not made before surgical intervention because clinical features are non-specific. However, it needs to be considered in women with acute lower abdominal pain with a unilateral cystic adnexal mass.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Liang-Ming
authors.initials: LM
authors.lastname: Lo
authors.forename: Shuenn-Dhy
authors.initials: SD
authors.lastname: Chang
authors.forename: Chyi-Long
authors.initials: CL
authors.lastname: Lee
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D000291:Adnexal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000293:Adolescent; D000328:Adult; D005184:Fallopian Tube Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D009325:Nausea / Q000175:diagnosis; D009929:Organ Size; D012189:Retrospective Studies; D058994:Salpingectomy; D014102:Torsion Abnormality / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult