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Case Report
An unexpected twist: Isolated fallopian tube torsion in a term nulliparous patient
1 Department of Obstetrics and Gynecology, New York University Grossman Long Island School of Medicine, Mineola, NY, USA
2 New York University Grossman Long Island School of Medicine, USA
3 Division of Maternal Fetal Medicine, New York University Grossman Long Island School of Medicine. Mineola, NY, USA
Address correspondence to:
Yael Eliner
222 Station Road, 5th floor, Mineola, NY 11501,
USA
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Article ID: 101545Z01CA2026
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Alterman C, Walker E, Gunabalan S, Eliner Y, Herman J, Wat K, Chavez M, Rekawek P. An unexpected twist: Isolated fallopian tube torsion in a term nulliparous patient. Int J Case Rep Images 2026;17(2):26–29.ABSTRACT
Introduction: Isolated fallopian tube torsion (IFTT) is the rotation of a fallopian tube without involvement of the ovary or adjacent vascular structures. It is a profoundly rare gynecologic emergency. Diagnosis is challenging because presenting symptoms and imaging findings are nonspecific and may be even more challenging during pregnancy due to the gravid uterus and attributing the pain to an obstetrical origin.
Case Report: We describe a case of a 20-year-old G1P0 patient who presented at 36 weeks and 6 days of gestation with acute right lower quadrant abdominal pain. Abdominal ultrasound was non-diagnostic, and abdominal magnetic resonance imaging demonstrated a nonspecific loculated fluid in the right lower quadrant. Fetal status was reactive and reassuring. Due to persistence of the pain despite administration of opioids and high levels of suspicion for adnexal torsion, the patient had a primary cesarean section and pelvic exploration that revealed a purple-black, edematous, necrotic right hydrosalpinx twisted more than six times. The patient had a concurrent salpingectomy. She was discharged from the hospital on postoperative day 2 with a healthy newborn.
Conclusion: This case highlights the importance of maintaining a high index of suspicion for IFTT in pregnant patients with severe, narcotic-refractory abdominal pain. Early recognition and prompt intervention are critical to optimize pregnancy outcomes.
Keywords: Abdominal pain, Fallopian tube torsion, Salpingectomy, Term pregnancy
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Acknowledgments
In accordance with the journal’s guidelines, AI was utilized for initial literature screening and review, but all intellectual content, data interpretation, and final drafting remain the responsibility of the authors. The authors used OpenEvidence AI Medical Knowledge Assistant at https://www.openevidence.com.
Author ContributionsCarly Alterman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Emma Walker - Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Silpaa Gunabalan - Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yael Eliner - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jonathan Herman - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Karyn Wat - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Martin Chavez - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Patricia Rekawek - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Carly Alterman et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
