Introduction Isolated torsion of fallopian tube is a rare cause of acute abdominal pain. It can happen in different portions of the oviduct: in our patient a torsion at the level of the infundibulum occurred.
Case report A 12-year-old post-menarchal girl presented at our Pediatric Surgery Unit with a two days history of lower abdominal pain on right side. Blood exams showed rise of CRP (19 mg/L) and normal WBC. An ultrasound performed in the A&E department was normal. Because of the persistence of pain, we repeated an ultrasound the day after that showed an anechogenic uniloculated 18 mm cyst at the level of the right ovary. The report was of functional follicular cyst.
After two days of observation and worsening of the symptoms, laparoscopy was performed: a necrosis of the fimbriae due to torsion at the right fallopian tube infundibulum was found. The ischaemic fimbriae were removed according to Kroener fimbriectomy. Hystological analysis described fimbriae characterized by oedema and vascular congestion.
Discussion Torsion of infundibulum could mimic a functional annessial cyst, with a normal echogenic appearance, while a torsion of the whole Fallopian tube can be more easily detected and suspected, avoiding delayed treatment. In our case, to base the management on clinical symptoms was mandatory.
Conclusions Isolated torsion of infundibulum of Fallopian tube is a challenging diagnosis. It should be considered in case of acute lower abdominal pain in young girls. Early laparoscopy seems to be the best approach for diagnosis and treatment.