Torsión aislada de la trompa de Falopio, con necrosis de un quiste paratubárico: una urgencia ginecológica infrecuente / Isolated torsion of the Fallopian tube, with necrosis of a paratubal cyst: an infrequent gynecological emergency

INTRODUCCIÓN: La torsión aislada de la trompa de Falopio ocurre en aproximadamente una de cada 50.000 a 1.500.000 mujeres, por ende, es una afección extremadamente rara. Fue originalmente descrita por Bland-Sutton en 1890. El cuadro clínico suele ser inespecífico y puede simular una amplia variedad de dolencias. CASO CLÍNICO: Paciente de 18 años de edad que acude al servicio de urgencias por dolor abdominal intenso, la cual se decide ingresar por cuadro agudo doloroso abdominal de posible etiología ginecológica, se realiza laparoscopía de urgencia por la posibilidad de un cuadro de torsión quística, durante esta se observa una imagen laparoscópica de la trompa izquierda violácea y torcida, además un quiste paratubárico hemorrágico, de color violacio; por las características laparoscópicas de la trompa y el quiste paratubárico que se relacionan con necrosis de estos elementos, se decide realizar a la paciente una anexectomía total izquierda con cistectomía del quiste paratubárico. DISCUSIÓN: La rotación de la trompa alrededor de su pedículo vascular es el evento fisiopatológico descrito, lo que provoca inicialmente la obstrucción del retorno venoso y linfático, con el consiguiente edema, ingurgitación y trombosis. Si la torsión progresa, y no se resuelve, se ve comprometida la vascularización arterial y se desencadena la necrosis del órgano y, finalmente la instauración de peritonitis, la conducta se basa en la viabilidad de la trompa: si no tiene signos de necrosis, la conducta indicada es destorcerla, si ya aparecieron signos de necrosis deberá ser extirpada.

INTRODUCTION: Isolated torsion of the Fallopian tube occurs in approximately one in every 50,000 to 1,500,000 women, therefore, it is an extremely rare condition. It was originally described by Bland-Sutton in 1890. The clinical picture is usually nonspecific and can mimic a wide variety of ailments. CLINICAL CASE: An 18-year-old patient who came to the emergency service for intense abdominal pain, which was decided to enter due to acute abdominal pain of possible gynecological etiology, an emergency laparoscopy was performed due to the possibility of a cystic torsion condition, During this, a laparoscopic image of the violaceous and crooked left tube is observed, as well as, a hemorrhagic paratubal cyst, violet in color; Due to the laparoscopic characteristics of the tube and the paratubal cyst that are related to necrosis of these elements, it was decided to perform a total left adnexectomy with cystectomy of the paratubal cyst. DISCUSSION: Rotation of the tube around its vascular pedicle is the described pathophysiological event, which initially causes obstruction of venous and lymphatic return, with the consequent edema, engorgement and thrombosis. If the torsion progresses and does not resolve, the arterial vascularization is compromised and the necrosis of the organ is triggered and, finally, the establishment of peritonitis, the behavior is based on the viability of the tube: if there are no signs of necrosis, the indicated conduct is to untwist it, if signs of necrosis have already appeared, it must be removed.

Torsión de quiste paratubárico: Reporte de caso / Paratubal cyst torsion: Case repor

Los quistes paratubáricos son estructuras quísticas simples llenas de líquido seroso ubicadas a lo largo de la trompa de Falopio, que generalmente se originan del ligamento ancho o el mesosálpinx. Es importante siempre considerar la torsión de la trompa como un diagnóstico diferencial en las pacientes que presentan dolor abdominal agudo y reconocer que se necesita un diagnóstico y tratamiento quirúrgico rápido para preservar la fertilidad de la paciente, especialmente aquellas en edad reproductiva. Se presenta el caso de una paciente de 16 años quien refirió dolor hipogástrico intenso junto con vómitos. Durante la laparoscopia, se encontró un quiste paratubárico torcido y se realizó la salpingectomía, debido a que la trompa derecha estaba deformada. El análisis histológico demostró que la tumoración era un quiste paratubárico.

Paratubal cysts are simple cystic structures filled with serous fluid that are located along the Fallopian tube, usually arising from the broad ligament or mesosalpinx. It is important to al ways consider tube torsion as a differential diagnosis for female patients presenting with an acute abdomen, and to be aware of the need for quick diagnosis and surgical treatment in order to preserve the patient's fertility, especially in younger patients of child-bearing age. We present the case of a 16 year-old female patient who complained of intense hypogastric pain together with vomits. During laparoscopy, a torted paratubal cyst was found in the right adnexa. Laparotomy was performed to remove the cyst and salpingectomy was carried out, since the right Fallopian tube was unsalvageable. Histological analysis showed that the mass was a paratubal cyst.

Acute abdomen due to ovarian congestion caused by coiling of the fallopian tube accompanied by paratubal cyst around the utero-ovarian ligament

Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an extremely rare case of acute abdomen induced by ovarian congestion triggered by the fallopian tube accompanying a paratubal cyst coiling around the utero-ovarian ligament. The right paratubal cyst was misinterpreted as being part of a cystic component of the left ovary on preoperative sonographic examination, and the coiling of the right fallopian tube accompanying the paratubal cyst was misdiagnosed as torsion of the right ovary. We report this rare case with a brief literature review.

Paratubal serous borderline tumor / 부인종양

Although paratubal cysts are well-characterized incidental findings, paratubal serous borderline tumors are very rare, with only one case report in the literature. We describe here a 27-year-old, nulliparous, married woman with a paratubal serous borderline tumor. The patient presented with a huge pelvic mass accompanied by flank pain and underwent paratubal cystectomy and fertility-sparing surgical staging procedures. Thirteen months after surgery, she delivered a healthy baby at term. She is well, without evidence of disease, 20 months after surgery. Because paratubal serous borderline tumors are very rare, their optimal management must be extrapolated from their ovarian counterparts.

Torsion of the paratubal cyst in an adolescent female: A case report / 대한산부인과학회지

Torsion of the paratubal cyst is a rare but significant cause of acute or recurrent lower abdominal pain in adolescent females that is difficult to recognize preoperatively. Early diagnosis is very important in adolescent because of the risk of decreased fertility if it is not treated at an early stage. We report a case of torsion of the paratubal cyst that has resulted in hemorrhagic infarction of the paratubal cyst and fallopian tube in an adolescent female with brief review of literatures.

Two cases of paratubal cysts manifesting as huge pelvic masses in young women / 대한산부인과학회지

Paratubal cysts come from paraovarium of the broad ligament between the fallopian tube and ovary. Overall, these cysts constitute 10% of all adnexal masses and are commonly incidental findings upon surgical exploration for other reasons. They more commonly occur in women between 30 and 40 years of age. We report two cases of rapidly growing, huge paratubal cysts in young women, which are presented with brief review of literature.