title: Isolated torsion of the fallopian tube in a menopausal woman and a pre-pubertal girl: two case reports.
abstract: BACKGROUND
  Isolated torsion of the fallopian tube without an ovarian abnormality is an uncommon event, with an incidence of approximately 1 in 1,500,000 females. Isolated torsion of the fallopian tube occurs mostly in reproductive-aged women, and is thus extremely rare in menopausal women and pre-pubertal girls.
  
  
  METHODS
  In case 1, 63-year-old Japanese woman presented with a 2-day history of acute lower abdominal pain. Menopause occurred at 53 years of age. Pelvic ultrasonography showed an enlarged mass (73 × 47 mm) on the right side of her uterus. An urgent laparoscopy was performed based on a presumptive diagnosis of right ovarian tumor torsion. During the laparoscopy, we noted a black, necrotic, solid tumor arising from the distal end of her right fimbria. Her right fallopian tube was twisted with the tumor, but her right ovary was normal and not involved. A laparoscopic tumorectomy with a right salpingectomy was performed. Her post-operative course was uneventful. In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting. Menarche had occurred 2 months earlier. A computed tomography and magnetic resonance imaging examination demonstrated a dilated tubal cystic mass with a normal uterus and bilateral ovaries. An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tube torsion. During laparoscopy, her right fallopian tube was noted to be dark red, dilated, and twisted several times. Her right fimbria was necrotic-appearing and could not be preserved. Therefore, a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, which was consistent with tubal torsion. She had an uncomplicated post-operative course.
  
  
  CONCLUSIONS
  We have presented two very rare cases of isolated fallopian tubal torsion. Radiologic interventions, such as computed tomography and magnetic resonance imaging, in addition to ultrasonography, are helpful diagnostic tools. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain with a cystic mass and a normal ipsilateral ovary in all female patients, regardless of age.
authors.affiliation: Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. m-toyo@med.tohoku.ac.jp.|Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. m-toyo@med.tohoku.ac.jp.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Toyoshima
authors.affiliation: Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. hika0305@yahoo.co.jp.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. inkjetkeitwo@yahoo.co.jp.
authors.forename: Kei
authors.initials: K
authors.lastname: Kudo
authors.affiliation: Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. medakayagi@hotmail.com.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yodogawa
authors.affiliation: Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. kazusato@olive.ocn.ne.jp.
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. zipperxxxty@snh.go.jp.
authors.forename: Takako
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. fuji3-saorin5@herb.ocn.ne.jp.
authors.forename: Saori
authors.initials: S
authors.lastname: Igeta
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. hmakino@snh.go.jp.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Makino
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. tshima@snh.go.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shima
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. rui_s@tim.hi-ho.ne.jp.
authors.forename: Rui
authors.initials: R
authors.lastname: Matsuura
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. ishigaki@snh.go.jp.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Ishigaki
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. akagik@snh.go.jp.
authors.forename: Kozo
authors.initials: K
authors.lastname: Akagi
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. takeyama@sendai.jrc.or.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takeyama
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. soredemokitamichi1119@yahoo.co.jp.|Department of Obstetrics and Gynecology, Self-Defense Force Sendai Hospital, Sendai, Japan. soredemokitamichi1119@yahoo.co.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Iwahashi
authors.affiliation: Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. y-kou-m@mtb.biglobe.ne.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yoshinaga
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D002648:Child; D005184:Fallopian Tube Diseases / Q000175:diagnosis* / Q000601:surgery*; D005187:Fallopian Tubes / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D058994:Salpingectomy; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000175:diagnosis* / Q000601:surgery*; D014463:Ultrasonography