Uncommon case of hydrosalpinx-induced adnexal torsion in a postmenopausal woman

Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with no pathological lesion in the ovary. The patient was discharged on the fourth postoperative day. Although adnexal torsion in postmenopausal women is a rare event, it should not be ignored in those women who present with abdominal pain. A longer delay between admission and surgery may be attributed to the rarity and nonspecific symptoms of the disease in this age group. Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Introduction Adnexal torsion is defined as twisting of the adnexa, including ovary and/or fallopian tube, around its own vascular axis. However the torsion may also affect only the ovary or fallopian tube. Although the exact incidence of adnexal torsion is unknown, it was reported to be diagnosed in 2.7% of gynecologic emergent surgeries. Most cases of adnexal torsion are in women of reproductive age; therefore, accurate diagnosis and treatment are essential to minimize ovarian injury and to preserve ovarian function. However, on some rare occasions, it is reported during pregnancy or in postmenopausal women. Furthermore, torsion of para ovarian and para fimbrial cysts may also occur. The differential diagnosis of adnexal torsion includes a list of gynecological conditions, such as pelvic inflammatory POG in Press, August 2017 Hydrosalpinx-induced adnexal torsion 2 disease (PID), twisted ovarian cyst and degenerated myoma, as well as nongynecological conditions, such as acute appendicitis. Because the clinical symptoms of adnexal torsion are nonspecific, the diagnosis is considered to be difficult, and a correct preoperative diagnosis is made in only 44% of cases. However, hydrosalpinx, a blocked, dilated, fluidfilled fallopian tube usually caused by a previous tubal infection, could be a risk factor. Here we report a case of a postmenopausal woman who presented with acute abdomen due to hydrosalpinx induced adnexal torsion.