Laparoscopic management of isolated fallopian tube torsion in the second trimester: a case report

Laparoscopic management of isolated fallopian tube torsion in the second trimester: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Laparoscopic management of isolated fallopian tube torsion in the second trimester: a case report Ying Jin, Shimao Zhang, Li He This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9325728/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Isolated fallopian tube torsion is a rare gynecological acute abdomen. Its clinical manifestations and imaging findings are non-specific, making preoperative diagnosis relatively challenging. Isolated fallopian tube torsion during pregnancy is even rarer, as the gravid uterus can cause patients' symptoms and signs to be easily confused with other acute abdominal conditions, such as acute appendicitis. Misdiagnosis, missed diagnosis, or delayed diagnosis may lead to insufficient blood supply or even necrosis of the torsed fallopian tube, ultimately affecting female fertility. Case presentation We report a case of isolated fallopian tube torsion in a 30-year-old Chinese woman who developed lower abdominal pain at 24 weeks of gestation. The pain initially localized to the right lumbar region and subsequently migrated to the right lower quadrant. The patient had a past medical history of right renal calculi and a right fallopian tube mesenteric cyst. Magnetic resonance imaging revealed a cyst approximately 3 cm in diameter in the right adnexal region. Due to the possibility of adnexal torsion, a laparoscopic exploration was performed. Intraoperatively, the right fallopian tube was found to have undergone four twists and appeared dark purple, while the right ovary, left adnexa, and appendix showed no abnormalities. Following detorsion, the tube remained persistently dark purple; consequently, a right salpingectomy was performed. Postoperatively, the patient continued the pregnancy to term and subsequently underwent a cesarean section. Conclusions In women with hydrosalpinx or paratubal cyst presenting with lower abdominal pain, the possibility of isolated fallopian tube torsion should be considered. When isolated fallopian tube torsion is suspected during pregnancy or the diagnosis of acute abdomen remains unclear, timely exploratory surgery is necessary. The decision to preserve the fallopian tube should be based on the degree of ischemia caused by the torsion. Early diagnosis and prompt surgical intervention can prevent necrotic changes due to torsion, thereby preserving the patient's natural fertility. Laparoscopy isolated fallopian tube torsion pregnancy image Figures Figure 1 Figure 2 Background Isolated fallopian tube torsion (IFTT) refers to torsion of the fallopian tube around its own axis with a normal ovarian position. It was first reported by Bland-Sutton in 1890 [ 1 ]. The incidence of IFTT is low, and only case reports and small case series have been documented. Delayed diagnosis and untimely surgery may lead to necrosis of the torsed fallopian tube, and even peritonitis, endangering maternal and fetal safety. Therefore, early diagnosis and surgical treatment of IFTT are crucial. This article describes a case of a woman at 24 weeks of gestation who presented with abdominal pain for three days and was ultimately diagnosed with IFTT and underwent salpingectomy via laparoscopic surgery, aiming to raise clinicians’ awareness of this condition. This manuscript is written following the CARE checklist . Case presentation A 30-year-old G1P0 Chinese woman at 24 weeks of gestation was admitted because of a 3-day history of right lower abdominal pain. She conceived via in vitro fertilization and embryo transfer. Her medical history included right renal calculi and a right paratubal cyst. Pain initially localized to the right lumbodorsal region, migrating to the right lower quadrant one day later. The pain gradually worsened in intensity, initially intermittent, later becoming persistent and severe, accompanied by dysuria. She had no fever, nausea, or vomiting during the course of the disease. Physical examination showed no percussion pain in the right renal region, and right lower quadrant tenderness, rebound, and guarding. Laboratory tests showed a white blood cell count of 12.5×10^9/L with 80% neutrophils. Urinalysis revealed red blood cells (+), white blood cells (+), and negative protein. Obstetric ultrasound indicated fetal size consistent with gestational age, but the adnexal region was poorly visualized. Urinary system ultrasound revealed a 0.5 cm right renal calculus with no significant dilation of the bilateral ureters. Abdominal magnetic resonance imaging (MRI) revealed a 2.3 cm × 2.8 cm cystic lesion in the right adnexal region with minimal fluid; the appendix was not significantly dilated (Fig. 1 ). To confirm the diagnosis, laparoscopic exploration was performed. Intraoperatively, the appendix appeared normal. The right fallopian tube had a mesosalpinx cyst, was twisted four times, and appeared dark purple (Fig. 2 ); the right ovary was normal. After detorsion, the tube remained dark purple following 10 minutes of observation, prompting right salpingectomy. Postoperatively, the patient continued the pregnancy to term and subsequently underwent a cesarean section. Discussion and conclusions Isolated fallopian tube torsion (IFTT) is rare, with an estimated incidence of 1 in 500,000 to 1,500,000 [ 2 ]; however, two cases during pregnancy have been diagnosed at our institution within the past year, suggesting the actual incidence may be higher. The majority of IFTT cases occur in non-pregnant individuals, with only approximately 12% of patients presenting during pregnancy. Risk factors include pelvic surgery, trauma, pelvic endometriosis, elongated fallopian tubes, hydrosalpinx, and uterine, ovarian, or paraovarian masses [ 3 ]. IFTT predominantly involves the right side and presents with non-specific symptoms such as vague abdominal pain, nausea, vomiting, dysuria, or defecation difficulties [ 3 ]. Some patients may present with mild symptoms, with fallopian tube torsion being incidentally detected during cesarean section. Physical examination reveals tenderness on the affected side. The differential diagnosis of IFTT during pregnancy includes common acute abdominal conditions, such as gynecological disorders (e.g., ovarian cyst rupture, ovarian torsion), surgical conditions (e.g., appendicitis, ureteral calculi, intestinal obstruction, intestinal perforation, and peritonitis), and obstetric conditions (e.g., threatened miscarriage, threatened preterm labor, placental abruption, and uterine rupture). Clinical symptoms may be confounded by features of threatened preterm labor or impending labor, thereby complicating diagnosis and treatment. In this patient, the initial symptom was right-sided low back pain, which was first thought by the patient to be caused by urolithiasis. At admission, the pain had shifted to the right lower abdomen, precluding the exclusion of acute appendicitis. Ultimately, pelvic MRI showed no appendiceal swelling but identified a cyst in the right adnexal area; thus, adnexal torsion was considered. Ultrasonography is the preferred imaging modality for evaluating abdominal pain during pregnancy; however, the sonographic appearance of IFTT typically presents as an elongated, coiled cystic mass adjacent to the uterine cornu, which is not pathognomonic. Moreover, the gravid uterus enlarges and displaces pelvic organs, increasing diagnostic difficulty. The overall diagnostic rate of ultrasonography for IFTT is approximately 30% [3]. MRI is valuable for assessing acute abdomen in pregnancy. MRI findings include plicae tubariae of the twisted fallopian tube and the whirlpool sign [4, 5, 6]. Given that the risks associated with acute abdominal conditions during pregnancy outweigh those associated with surgical intervention, early surgical treatment is recommended once IFTT is confirmed or highly suspected. Surgical approaches include laparoscopy and laparotomy. There is currently no consensus on whether to preserve the fallopian tube in patients with IFTT. Some scholars argue that preserving a damaged fallopian tube may lead to postoperative hydrosalpinx, potentially exerting a greater adverse impact on fertility, and therefore recommend salpingectomy. In contrast, others contend that, drawing on the management principles of ovarian cyst torsion, the fallopian tube should be preserved whenever possible to maintain natural fertility [1]. Some investigators suggest intraoperative evaluation of the fallopian tube, with clinical management guided by its gross appearance. In the present case, our initial intention was to preserve the fallopian tube; however, following detorsion, the tube failed to exhibit restored blood supply and remained dark purple in appearance. Given the concern for tubal necrosis, salpingectomy was ultimately performed. In pregnant patients presenting with unexplained abdominal pain-particularly those with a history of hydrosalpinx or paratubal cyst, or those undergoing assisted reproduction due to infertility-the possibility of IFTT should be considered. When ultrasonography fails to yield a definitive diagnosis, prompt MRI is warranted. Timely surgical exploration is indicated when IFTT is suspected or the diagnosis remains unclear. The decision to preserve the fallopian tube may be guided by intraoperative findings, and the choice of surgical approach should be individualized based on gestational age and the surgeon’s expertise. Abbreviations IFTT isolated fallopian tube torsion Declarations Ethics approval and consent to participate The patient consented to inclusion in this report. Consent for publication Written informed consent was obtained from the patient for publication of this case report. A copy of the signed written consent form is available for review by the Editor-in-Chief of this journal. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors’ contributions YJ and SMZ designed the study and contributed to the writing of the manuscript. SMZ performed the operation. All authors have read and approved the final manuscript. Acknowledgments We thank the patient and her family for their consent to participate, as well as the doctors who have contributed to the diagnosis and treatment. Author details Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China. Chengdu, China. References Bland-Sutton J. Salpingitis and some of its effects [J]. Lancet, 1890, 136:1146–8. Hagege R, Sharvit M, Hamou B, et al. Isolated Fallopian Tube Torsion: An Under-diagnosed Entity with Debatable Management. J Minim Invasive Gynecol. 2022;29(1):158–63. Varghese S, Seldon Y, Raperport C, et al. Isolated fallopian tube torsion: A systematic review of case reports. Eur J Obstet Gynecol Reprod Biol. 2024;296:140–7. Sakuragi M, Kido A, Himoto Y, et al. MRI findings of isolated tubal torsions: case series of 12 patients. Clin Imaging. 2017;41:28–32. Coutureau J, Mandoul C, Curros-Doyon F, et al. Recognizing the features of Isolated Fallopian Tube Torsion on CT and MRI and interobserver agreement: A cross-sectional study. Eur J Radiol. 2022;157:110607. Takeda A, Kitami K, Shibata M. Magnetic resonance imaging and gasless laparoendoscopic single-site surgery for the diagnosis and management of isolated tubal torsion with a paratubal cyst at 31 weeks of gestation: A case report and literature review. J Obstet Gynaecol Res. 2020;46(8):1450–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 13 Apr, 2026 Editor assigned by journal 07 Apr, 2026 Submission checks completed at journal 07 Apr, 2026 First submitted to journal 05 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9325728","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":624809059,"identity":"4c21ed50-91e5-4aab-b207-323b7777c8df","order_by":0,"name":"Ying Jin","email":"","orcid":"","institution":"Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Jin","suffix":""},{"id":624809062,"identity":"a88ce6e2-bf60-49ea-9c77-d1876a20209e","order_by":1,"name":"Shimao Zhang","email":"","orcid":"","institution":"Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"prefix":"","firstName":"Shimao","middleName":"","lastName":"Zhang","suffix":""},{"id":624809065,"identity":"0bf27fa2-f9f8-4e3c-894f-4882d2d7a2bd","order_by":2,"name":"Li He","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIiWNgGAWjYBACAwbmhgNAOoGfmfnwAyK1MEK0SLazpRkQrQVEJxic51GQIEqLOXtj42GeGrs848M8QP01NtEEtVj2HGw4zHMsudjsMO+BBwzH0nIbCDrsRmLD4dyGA4nbDvMlGDCC2AS13H8I0bK5mcdAgjgtNxghWjYwE63lDNBhf44lJ844DAzkBKL8cvzw4Y8zauwS+/sPH37wocaGsBZUkECa8lEwCkbBKBgFuAAAOkdGWTM8/3sAAAAASUVORK5CYII=","orcid":"","institution":"Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"He","suffix":""}],"badges":[],"createdAt":"2026-04-05 10:53:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9325728/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9325728/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107258548,"identity":"9f6624b1-718b-4585-91f6-401d61c42238","added_by":"auto","created_at":"2026-04-19 12:39:40","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97589,"visible":true,"origin":"","legend":"\u003cp\u003eThe right adnexal region shows a cyst with minimal surrounding fluid.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9325728/v1/da520f3b287eba45a520dddb.jpg"},{"id":107258555,"identity":"e02b2d5d-810b-4985-9cee-75770463a1cf","added_by":"auto","created_at":"2026-04-19 12:39:44","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":136880,"visible":true,"origin":"","legend":"\u003cp\u003eThe right fallopian tube appears dark purple with four twists; the right ovary is normal.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9325728/v1/9362f1d953afee0e0ff2362a.jpg"},{"id":109295865,"identity":"7356d702-c564-4edc-8120-9faff49436f5","added_by":"auto","created_at":"2026-05-15 08:38:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":333537,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9325728/v1/d5703911-3242-46e4-a4d4-cf7bdca0b929.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Laparoscopic management of isolated fallopian tube torsion in the second trimester: a case report","fulltext":[{"header":"Background","content":"\u003cp\u003eIsolated fallopian tube torsion (IFTT) refers to torsion of the fallopian tube around its own axis with a normal ovarian position. It was first reported by Bland-Sutton in 1890 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The incidence of IFTT is low, and only case reports and small case series have been documented. Delayed diagnosis and untimely surgery may lead to necrosis of the torsed fallopian tube, and even peritonitis, endangering maternal and fetal safety. Therefore, early diagnosis and surgical treatment of IFTT are crucial. This article describes a case of a woman at 24 weeks of gestation who presented with abdominal pain for three days and was ultimately diagnosed with IFTT and underwent salpingectomy via laparoscopic surgery, aiming to raise clinicians\u0026rsquo; awareness of this condition. This manuscript is written following the CARE checklist .\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 30-year-old G1P0 Chinese woman at 24 weeks of gestation was admitted because of a 3-day history of right lower abdominal pain. She conceived via in vitro fertilization and embryo transfer. Her medical history included right renal calculi and a right paratubal cyst. Pain initially localized to the right lumbodorsal region, migrating to the right lower quadrant one day later. The pain gradually worsened in intensity, initially intermittent, later becoming persistent and severe, accompanied by dysuria. She had no fever, nausea, or vomiting during the course of the disease. Physical examination showed no percussion pain in the right renal region, and right lower quadrant tenderness, rebound, and guarding. Laboratory tests showed a white blood cell count of 12.5×10^9/L with 80% neutrophils. Urinalysis revealed red blood cells (+), white blood cells (+), and negative protein. Obstetric ultrasound indicated fetal size consistent with gestational age, but the adnexal region was poorly visualized. Urinary system ultrasound revealed a 0.5 cm right renal calculus with no significant dilation of the bilateral ureters. Abdominal magnetic resonance imaging (MRI) revealed a 2.3 cm × 2.8 cm cystic lesion in the right adnexal region with minimal fluid; the appendix was not significantly dilated (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). To confirm the diagnosis, laparoscopic exploration was performed. Intraoperatively, the appendix appeared normal. The right fallopian tube had a mesosalpinx cyst, was twisted four times, and appeared dark purple (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e); the right ovary was normal. After detorsion, the tube remained dark purple following 10 minutes of observation, prompting right salpingectomy. Postoperatively, the patient continued the pregnancy to term and subsequently underwent a cesarean section.\u003c/p\u003e "},{"header":"Discussion and conclusions","content":"\u003cp\u003eIsolated fallopian tube torsion (IFTT) is rare, with an estimated incidence of 1 in 500,000 to 1,500,000 [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]; however, two cases during pregnancy have been diagnosed at our institution within the past year, suggesting the actual incidence may be higher. The majority of IFTT cases occur in non-pregnant individuals, with only approximately 12% of patients presenting during pregnancy. Risk factors include pelvic surgery, trauma, pelvic endometriosis, elongated fallopian tubes, hydrosalpinx, and uterine, ovarian, or paraovarian masses [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. IFTT predominantly involves the right side and presents with non-specific symptoms such as vague abdominal pain, nausea, vomiting, dysuria, or defecation difficulties [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]. Some patients may present with mild symptoms, with fallopian tube torsion being incidentally detected during cesarean section. Physical examination reveals tenderness on the affected side. The differential diagnosis of IFTT during pregnancy includes common acute abdominal conditions, such as gynecological disorders (e.g., ovarian cyst rupture, ovarian torsion), surgical conditions (e.g., appendicitis, ureteral calculi, intestinal obstruction, intestinal perforation, and peritonitis), and obstetric conditions (e.g., threatened miscarriage, threatened preterm labor, placental abruption, and uterine rupture). Clinical symptoms may be confounded by features of threatened preterm labor or impending labor, thereby complicating diagnosis and treatment. In this patient, the initial symptom was right-sided low back pain, which was first thought by the patient to be caused by urolithiasis. At admission, the pain had shifted to the right lower abdomen, precluding the exclusion of acute appendicitis. Ultimately, pelvic MRI showed no appendiceal swelling but identified a cyst in the right adnexal area; thus, adnexal torsion was considered.\u003c/p\u003e\u003cp\u003eUltrasonography is the preferred imaging modality for evaluating abdominal pain during pregnancy; however, the sonographic appearance of IFTT typically presents as an elongated, coiled cystic mass adjacent to the uterine cornu, which is not pathognomonic. Moreover, the gravid uterus enlarges and displaces pelvic organs, increasing diagnostic difficulty. The overall diagnostic rate of ultrasonography for IFTT is approximately 30% [3]. MRI is valuable for assessing acute abdomen in pregnancy. MRI findings include plicae tubariae of the twisted fallopian tube and the whirlpool sign [4, 5, 6].\u003c/p\u003e\n\u003cp\u003eGiven that the risks associated with acute abdominal conditions during pregnancy outweigh those associated with surgical intervention, early surgical treatment is recommended once IFTT is confirmed or highly suspected. Surgical approaches include laparoscopy and laparotomy. There is currently no consensus on whether to preserve the fallopian tube in patients with IFTT. Some scholars argue that preserving a damaged fallopian tube may lead to postoperative hydrosalpinx, potentially exerting a greater adverse impact on fertility, and therefore recommend salpingectomy. In contrast, others contend that, drawing on the management principles of ovarian cyst torsion, the fallopian tube should be preserved whenever possible to maintain natural fertility [1]. Some investigators suggest intraoperative evaluation of the fallopian tube, with clinical management guided by its gross appearance. In the present case, our initial intention was to preserve the fallopian tube; however, following detorsion, the tube failed to exhibit restored blood supply and remained dark purple in appearance. Given the concern for tubal necrosis, salpingectomy was ultimately performed.\u003c/p\u003e\n\u003cp\u003eIn pregnant patients presenting with unexplained abdominal pain-particularly those with a history of hydrosalpinx or paratubal cyst, or those undergoing assisted reproduction due to infertility-the possibility of IFTT should be considered. When ultrasonography fails to yield a definitive diagnosis, prompt MRI is warranted. Timely surgical exploration is indicated when IFTT is suspected or the diagnosis remains unclear. The decision to preserve the fallopian tube may be guided by intraoperative findings, and the choice of surgical approach should be individualized based on gestational age and the surgeon\u0026rsquo;s expertise.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIFTT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eisolated fallopian tube torsion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient consented to inclusion in this report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report. A copy of the signed written consent form is available for review by the Editor-in-Chief of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYJ and SMZ designed the study and contributed to the writing of the manuscript. SMZ\u0026nbsp;performed the operation.\u0026nbsp;All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the patient and her family for their consent to participate, as well as the doctors who have contributed to the diagnosis and treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China. Chengdu, China.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBland-Sutton J. Salpingitis and some of its effects [J]. Lancet, 1890, 136:1146\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagege R, Sharvit M, Hamou B, et al. Isolated Fallopian Tube Torsion: An Under-diagnosed Entity with Debatable Management. J Minim Invasive Gynecol. 2022;29(1):158\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarghese S, Seldon Y, Raperport C, et al. Isolated fallopian tube torsion: A systematic review of case reports. Eur J Obstet Gynecol Reprod Biol. 2024;296:140\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakuragi M, Kido A, Himoto Y, et al. MRI findings of isolated tubal torsions: case series of 12 patients. Clin Imaging. 2017;41:28\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoutureau J, Mandoul C, Curros-Doyon F, et al. Recognizing the features of Isolated Fallopian Tube Torsion on CT and MRI and interobserver agreement: A cross-sectional study. Eur J Radiol. 2022;157:110607.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakeda A, Kitami K, Shibata M. Magnetic resonance imaging and gasless laparoendoscopic single-site surgery for the diagnosis and management of isolated tubal torsion with a paratubal cyst at 31 weeks of gestation: A case report and literature review. J Obstet Gynaecol Res. 2020;46(8):1450\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Laparoscopy, isolated fallopian tube torsion, pregnancy, image","lastPublishedDoi":"10.21203/rs.3.rs-9325728/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9325728/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIsolated fallopian tube torsion is a rare gynecological acute abdomen. Its clinical manifestations and imaging findings are non-specific, making preoperative diagnosis relatively challenging. Isolated fallopian tube torsion during pregnancy is even rarer, as the gravid uterus can cause patients' symptoms and signs to be easily confused with other acute abdominal conditions, such as acute appendicitis. Misdiagnosis, missed diagnosis, or delayed diagnosis may lead to insufficient blood supply or even necrosis of the torsed fallopian tube, ultimately affecting female fertility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe report a case of isolated fallopian tube torsion in a 30-year-old Chinese woman who developed lower abdominal pain at 24 weeks of gestation. The pain initially localized to the right lumbar region and subsequently migrated to the right lower quadrant. The patient had a past medical history of right renal calculi and a right fallopian tube mesenteric cyst. Magnetic resonance imaging revealed a cyst approximately 3 cm in diameter in the right adnexal region. Due to the possibility of adnexal torsion, a laparoscopic exploration was performed. Intraoperatively, the right fallopian tube was found to have undergone four twists and appeared dark purple, while the right ovary, left adnexa, and appendix showed no abnormalities. Following detorsion, the tube remained persistently dark purple; consequently, a right salpingectomy was performed. Postoperatively, the patient continued the pregnancy to term and subsequently underwent a cesarean section.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn women with hydrosalpinx or paratubal cyst presenting with lower abdominal pain, the possibility of isolated fallopian tube torsion should be considered. When isolated fallopian tube torsion is suspected during pregnancy or the diagnosis of acute abdomen remains unclear, timely exploratory surgery is necessary. The decision to preserve the fallopian tube should be based on the degree of ischemia caused by the torsion. Early diagnosis and prompt surgical intervention can prevent necrotic changes due to torsion, thereby preserving the patient's natural fertility.\u003c/p\u003e","manuscriptTitle":"Laparoscopic management of isolated fallopian tube torsion in the second trimester: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 12:38:31","doi":"10.21203/rs.3.rs-9325728/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-17T08:31:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253865903929503278590914980164683541343","date":"2026-04-15T06:53:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T06:33:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-07T05:22:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-07T05:22:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-04-05T10:46:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0be5333-c7f5-4fca-b284-15a21f11a8c0","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T12:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 12:38:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9325728","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9325728","identity":"rs-9325728","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}