First documented case of cervical stenosis resulting in pyometra and fallopian tube torsion

INTRODUCTION: Cervical stenosis (CS) is a condition characterized by the narrowing of the cervical canal, which can lead to complications such as pyometra and fallopian tube torsion (FTT). The interplay of these conditions is rarely documented in the literature. CASE PRESENTATION: A 60-year-old Ethiopian woman, with a history of recurrent genitourinary infections and 16 years post-menopausal, presented with sudden onset right-sided lower abdominal pain, nausea, and foul-smelling vaginal discharge. Physical examination revealed a mass consistent with a 14-week size uterus and tachycardia. Ultrasound showed an endometrial fluid collection and an enlarged right adnexal mass. Laparotomy confirmed a necrotic right fallopian tube after a 1080-degree torsion and evacuation of frank pus was performed due to an obstructed cervix. DISCUSSION: The case illustrates a rare association between CS, pyometra, and FTT. Pyometra requires both an endometrial infection and cervical obstruction for fluid accumulation, leading to significant abdominal symptoms. The effectiveness of imaging methods for diagnosing FTT is limited, necessitating surgical intervention for definitive management. CONCLUSION: This unique case highlights the importance of considering rare complications such as fallopian tube torsion in patients with pyometra due to cervical stenosis. Early diagnosis and intervention are crucial to prevent necrosis and ensure successful treatment outcomes.