Pediatric isolated fallopian tube torsion

Isolated fallopian tube torsion (IFTT) is an isolated rotation of the fallopian tube around itself, without torsion of the ovary. The incidence of fallopian tube torsion is one in 1,500,000 adults. IFTT is less frequent in children and teenagers then in adults, but the real incidence in pediatric patients is difficult to determine, because rarely reported in the literature. IFTT generally occurs as adnexal torsion caused by a concomitant ovarian pathology. In adult age several intrinsic or extrinsic predisposing factors have been identified leading to IFTT while in the pediatric age group the possible factors are preexisting congenital malformations such as hydrosalpinx (HSX). Primary causes are anatomical, such as abnormality of length, mobility and structure. Secondary causes are acquired including infections, adhesions, endometriosis and neoplasms. Both primary and secondary causes are likely to be responsible for pediatric tubal disease. IFTT is a rare cause of abdominal pain often presents with aspecific abdominal pain (acute or chronic). Diagnosis appears difficult to obtain with standard diagnostic procedures and in most patients a definitive diagnosis is obtained only through a surgical exploration. Operative procedures range from salpingectomy to conservative management with de-torsion of the tube unless there is evidence of necrosis or rupture. However, surgical remedy of the torsed tube is controversial. This chapter reports common presenting signs, symptoms, and radiological findings as well different surgical options available and adopted, focusing on the current management and the preservation of fertility in these young patients with this rare pediatric entity.