A Case of Isolated Fallopian Tube Torsion Associated with Hematosalpinx in a 13-year-old Girl

Isolated fallopian tube torsion without involving ovary is a very rare condition in the pediatric population.
The incidence of IFFT is approximately one in 1.5 million females.
Several intrinsic or extrinsic predisposing factors have been identified in adults. However, in sexually inactive girls or adolescents, a possible factor is preexisting congenital malformations.
Torsion of the right tube is much more common than left, which could be related to protective effect of sigmoid colon and mesentery, or to more frequent imaging evaluations of right pelvis pain to investigate possible appendicitis.
Accompanying symptoms are very nonspecific, such as nausea, vomiting and with appendicitis-like symptoms. Because of its rarity and non-specific symptoms, it is usually misdiagnosed initially, with the expense of loss of fertility.
This condition is hard to diagnose with standard imaging tests, and surgical examination is needed to make a final diagnosis. Treatment of IFTT ranges from a wait-and-see approach to total salpingectomy and early diagnosis is essential for conservative management. So it should be considered as a differential diagnosis in pediatric pelvic abdominal pain, especially if ultrasound study reveals a pelvic tubular structure without involvement of the ovary.
Here, we report a very rare case of IFTT associated with hematosalpinx in a thirteen years old girl, who presented with acute abdominal pain. Gray scale, color doppler ultrasound and MRI with contrast were performed and revealed the diagnosis. Previous literature of IFTT in reproductive and pediatric age groups are reviewed and the imaging features of this patient are discussed.