Innocent until proven guilty: acute on chronic tubal torsion mimicking pelvic inflammatory disease

Acute pelvic pain is a common complaint in reproductive age women and has a large differential diagnosis. Decision for conservative vs. surgical management is often dependent on clinical, biochemical and imaging findings. Isolated tubal torsion is a rare cause of pelvic pain that requires prompt diagnosis and surgical management to avoid morbidity. Here, we report non-pregnant women of reproductive age presenting with acute lower abdominal pain. Raised inflammatory markers and ultrasound findings prompted management for Pelvic Inflammatory Disease. Despite some improvement with antibiotics, the patient had ongoing symptoms. At surgery, bilateral para-tubal cysts and a left sided hydrosalpinx were found, along with an isolated left tubal torsion. Isolated tubal torsion most commonly occurs in reproductive aged women, and risk factors include intrinsic tubal pathology and extrinsic lesions. Clinically, biochemically and radiographically, it is often indistinguishable from other pelvic pathology, potentially leading to diagnostic delay, and necrosis of the tube.