Isolated right fallopian tube torsion associated with hydrosalpinx and multiple uterine leiomyomas in a 50-year-old woman: a case report

BACKGROUND: Isolated fallopian tube torsion (IFTT) is a rare gynecologic emergency that frequently presents with nonspecific symptoms and may mimic other causes of acute abdominal pain, resulting in diagnostic delay. CASE PRESENTATION: A 50-year-old woman presented with a 2-day history of right lower quadrant pain without gastrointestinal, urinary, or gynecologic symptoms and was initially admitted with suspected appendicitis. Pelvic ultrasonography demonstrated right hydrosalpinx with absent Doppler flow, while contrast-enhanced computed tomography revealed a 6 cm × 2.5 cm hydrosalpinx with a possible whirlpool sign, multiple calcified uterine fibroids, and a cervical lesion; the appendix was normal. Based on the clinical and radiologic findings, right fallopian tube torsion was suspected. Owing to the presence of multiple large fibroids and concern for possible sarcomatous change, the patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Intraoperatively, a gangrenous, torsed right fallopian tube and a bulky, fibroid uterus were identified. Histopathological examination confirmed ischemic necrosis of the right fallopian tube consistent with torsion and demonstrated benign leiomyomata with hyalinization and calcification, without evidence of malignancy. CONCLUSION: IFTT should be considered in women presenting with acute unilateral lower abdominal pain. Early recognition and prompt surgical intervention are essential for definitive diagnosis and prevention of adverse outcomes.