Isolated torsion of the fallopian tube during pregnancy
Background: Isolated torsion of the fallopian tube (IFTT) is extremely rare – in 1 out of 1500,000 patients. Its possible causes include anomalies of the structure of the fallopian tubes, paraovarial cysts, hydrosalpinx, long mesosalpinx, hydatids of Morgagni. The main clinical manifestations are nonspecific: sudden pain in the lower abdomen, accompanied by nausea, vomiting and frequent urination. Visualization during instrumental research is difficult. The preferred method of treatment that allows to preserve the organ, and hence the fertility of the patient, is the detorsion of the fallopian tube, with the ineffectiveness of which tubectomy is indicated.Strizhakov A.N., Ignatko I.V., Bogomazova I.M., Belousova V.S., Grigoryan I.S., Korchagina M.O.
Case report: A first-pregnant patient at 35–36 weeks gestation went to an obstetric hospital with complaints for pain in the ilio-lumbar region on the right. Palpation revealed soreness in the right iliac region and a weakly positive symptom of pounding on the lower back on the right. Ultrasound examination of the kidneys revealed right-sided pyelokalikoectasia, the patient was diagnosed with gestational pyelonephritis and underwent infusion, antispasmodic and antimicrobial therapy, as well as drainage of the right calyx-pelvic system. Taking into account the persistent pain syndrome, the appearance of symptoms of peritoneal irritation and the detection of free fluid in the abdominal cavity, the pregnant woman underwent a diagnostic laparotomy, which revealed necrotic changes in the right fallopian tube against the background of its isolated torsion. Tubectomy was performed.
Conclusion: The expansion of the calyx-pelvic system in patients in the second half of pregnancy is due to a violation of the passage of urine due to compression of the ureters by the growing uterus. Stagnation of urine in the cup-pelvic system is a favorable environment for the reproduction of opportunistic microorganisms with the development of gestational pyelonephritis, which is a risk factor for severe maternal and perinatal complications. In this clinical observation, the most probable diagnosis for pregnant women was established – gestational pyelonephritis – with appropriate treatment, which turned out to be ineffective. Diagnostic laparotomy was delayed, and therefore organ-preserving treatment in the amount of detorsion was inappropriate and the necrotically altered fallopian tube was removed.
Keywords
torsion of the uterine appendages
isolated torsion of the fallopian tube
acute abdomen
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Received 21.04.2022
Accepted 01.06.2022
About the Authors
Alexander N. Strizhakov, Dr. Med. Sci., Academician of the RAS, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, strizhakov_a_n@staff.sechenov.ru, 119991, Russian Federation, Moscow, Trubetskaya str., 8-2.Irina V. Ignatko, Dr. Med. Sci., Corresponding Member of RAS, Professor of RAS, Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, kafedra-agp@mail.ru, 119991, Russian Federation, Moscow, Trubetskaya str., 8-2.
Irina M. Bogomazova, PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499) 782-30-45, +7(926)305-04-03, bogomazova_i_m@staff.sechenov.ru, https://orcid.org/0000-0003-1156-7726, 19991, Russian Federation, Moscow, Trubetskaya str., 8-2.
Vera S. Belousova, Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(499)782-30-45, belousova_v_s@staff.sechenov.ru, 119991, Russian Federation, Moscow, Trubetskaya str., 8-2.
Irina S. Grigoryan, 2nd year Resident at the Department of Obstetrics, Gynecology and Perinatology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(919)100-31-66, irina_grs@mail.ru, 119991, Russian Federation, Moscow, Trubetskaya str., 8-2.
Maria O. Korchagina, 2nd year Resident at the Department of Obstetrics, Gynecology and Perinatology, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov
First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), +7(915)337-51-25, mashulia96@list.ru,
119991, Russian Federation, Moscow, Trubetskaya str., 8-2.
Corresponding author: Irina M. Bogomazova, bogomazova_i_m@staff.sechenov.ru
Authors' contributions: Strizhakov A.N., Ignatko I.V., Belousova V.S. – concept and design of the study, editing; Bogomazova I.M., Grigoryan I.S., Korchagina M.O. – collection and processing of the material, statistical data processing, writing and text.
Conflicts of interest: The authors declare lack of the possible conflicts of interest.
Funding: The authors declare lack of the funding.
Patient Consent for Publication: The patient provided informed consent for the publication of her data and associated images.
For citation: Strizhakov A.N., Ignatko I.V., Bogomazova I.M., Belousova V.S., Grigoryan I.S., Korchagina M.O. Isolated torsion of the fallopian tube during pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 8: 170-175 (in Russian)
https://dx.doi.org/10.18565/aig.2021.8.170-175
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