title: A rare case of right lower quadrant abdominal pain.
abstract: Isolated fallopian tube torsion without involvement of the ovary is a rare condition most frequently presenting during reproductive years. Imaging, vitals, physical exam, and laboratory findings all fail to help establish a definitive diagnosis. The majority of the diagnoses are made on the operating table. Physical exam most often reveals unilateral and localized abdominal pain, often with nausea and vomiting, but few other reliably common findings. Diagnosis becomes even more challenging due to the fact that isolated tubal torsion occurs often in pregnancy and preferentially on the right, further complicating the clinical picture. We describe a case of isolated tubal torsion, unique in that localized necrosis and inflammation from the torsion triggered a secondary appendicitis. The patient required surgical intervention, and an appendectomy and salpingectomy emergently. Given its elusive and rare nature, awareness and early intervention is required by the emergency physician to recognize tubal torsion, as operative intervention is crucial, and can lead to preservation of fertility and improved fetal survival.
authors.affiliation: Henry Ford Allegiance Health, Emergency Department, 205 N East Ave, Jackson, MI 48103, United States. Electronic address: macedom@gmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Macedo
authors.affiliation: Henry Ford Allegiance Health, Emergency Department, 205 N East Ave, Jackson, MI 48103, United States. Electronic address: ermed@comcast.net.
authors.forename: Brian
authors.initials: B
authors.lastname: Kim
authors.affiliation: Henry Ford Allegiance Health, Emergency Department, 205 N East Ave, Jackson, MI 48103, United States. Electronic address: rami.khory@allegiancehealth.org.
authors.forename: Rami
authors.initials: R
authors.lastname: Khoury
authors.affiliation: Henry Ford Allegiance Health, Department of Surgery, 205 N East Ave, Jackson, MI 48103, United States.
authors.forename: Larry
authors.initials: L
authors.lastname: Narkiewicz
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005184:Fallopian Tube Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D058994:Salpingectomy; D014102:Torsion Abnormality / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Appendicitis; Isolated fallopian torsion; Pregnancy; Tubal torsion