Laparoscopic Approach to Tubal Torsion in the Pregnant Patient

Study Objective To highlight the diagnosis and management of fallopian tube torsion and address laparoscopic modifications in pregnancy for patient safety. Design Case report. Setting Academic based community hospital. Patients or Participants 23-year-old multigravida at 18 weeks 5 days gestation presented to the emergency department for intermittent right flank and groin pain. Ultrasound, which confirmed dating, showed possible 5-centimeter hemorrhagic cyst with blood flow, although ovarian torsion could not be excluded. Pelvic magnetic resonance imaging, while unable to visualize the appendix, did reveal a right-sided pelvic mass with surrounding cystic fluid. She was admitted for observation and pain control, but her symptoms continued to worsen. Interventions Emergent operative laparoscopy was performed with pregnancy modifications of left lateral tilt, supra-umbilical abdominal entry, and secondary port placement in right upper quadrant. During the procedure, a gravid uterus with normal appearing bilateral ovaries and left fallopian tube was noted. There was a 4-centimeter isolated right fallopian tube torsion. Right salpingectomy was performed without complications for the patient and fetus. Post-operative fetal cardiac activity was confirmed. Surgical pathology noted benign right fallopian tube with hemorrhage. Measurements and Main Results Pregnancy is a known risk factor for tubal torsion, with an annual prevalence of 1 in 1.5 million. Presenting symptoms are nonspecific, making diagnosis difficult. Imaging is generally unreliable; however, an ultrasound may reveal a dilated fallopian tube with absent blood flow. Definitive treatment is surgical detorsion, fixation, or salpingectomy. With pregnancy, surgical considerations such as trocar placement, positioning, equipment selection, and fetal monitoring based on gestational age are important. Medically necessary urgent or emergent surgical treatment should not be delayed. Conclusion Fallopian tubal torsion is a rare condition. Surgical treatment with laparoscopy can be safely performed in pregnancy with modifications to overcome the challenges of the unique anatomy and physiology of pregnancy.