Rare Twist: Unusual Case of Isolated Fallopian Tube Torsion with Hematosalpinx

Introduction:It is extremely uncommon for isolated fallopian tube torsion to develop without ipsilateral ovarian involvement.Fallopian tube necrosis and gangrenous transformation are two consequences of tubal torsion that raise the risk of superinfection and peritonitis.Torsion must be managed immediately in order to avoid permanent damage.Case description: A 39-year-old, unmarried, and nulliparous woman presented in August 2024 to the emergency department (ED) with the chief complaints of acute right-sided abdominal pain.An emergency ultrasound was performed and it reported a large cyst in the right adnexa with internal septation and a thickened tube.The imaging did not report any torsion or hematosalpinx.The patient underwent an emergency laparotomy in view of a suspected torsion, which revealed obvious isolated torsion of a hematosalpinx with an ipsilateral normal ovary.Salpingectomy was performed because the fallopian tube showed gangrenous changes, and the ipsilateral ovary was preserved.The patient recovered completely within 3 days after surgery.Conclusion: This is a rare case of isolated hematosalpinx torsion with no ipsilateral ovarian involvement.The usual presentation of torsion involves the entire ipsilateral adnexa but, in this case, the ipsilateral ovary was spared.Since the fallopian tube involved in the torsion had progressed to necrosis, a salpingectomy was performed with preservation of the ipsilateral ovary.