Department of Obstetrics and Gynecology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
Eur J Obstet Gynecol Reprod Biol. 2009 Oct;146(2):116-20. doi: 10.1016/j.ejogrb.2009.05.002. Epub 2009 Jun 2.
Adnexal torsion is an uncommon cause of acute abdomen in pregnancy and isolated fallopian tube twisting accounts for a very small number of these cases. These conditions, either in pregnancy or in non-gestational circumstances, are known to be due to both genital and non-genital causes and, in most cases, predisposing factors can be identified. We reviewed the literature and retrieved only 19 cases of isolated fallopian tube torsion in pregnancy treated surgically from 1936 to today, including one recently published case from our experience. The clinical presentation was lower quadrant abdominal pain in all cases. The right side was involved in 90% of the cases. Tenderness was usually present but peritoneal irritation with guarding or rebound was exceptional. Symptoms were nausea and vomiting, scanty vaginal bleeding and dysuria. Signs suggestive of necrosis such as leucocytosis, increased CRP and mild hyperpyrexia were uncommon. Preoperative ultrasound evaluation was performed in eight patients and in all cases an adnexal cyst was detected on the ipsilateral side of the abdominal pain. The case we recently published was carefully investigated preoperatively by Doppler flow ultrasound techniques which allowed for a precise differential diagnosis with total adnexal torsion. This aspect has never been previously considered. The surgical approach showed acute isolated fallopian tube torsion in all the cases and a predisposing factor was identified in 75% of the patients. Foetal and maternal outcome were always excellent. In cases of acute abdomen in pregnancy, with detailed Doppler flow ultrasound evidence of normal ovaries and of a pelvic cyst, an isolated tubal-paratubal cyst torsion should be considered and appropriate ovary-sparing surgical treatment foreseen.
附件扭转是妊娠急性腹痛的不常见原因，而孤立的输卵管扭转在这些病例中占很小比例。这些情况无论是在妊娠期间还是非妊娠期间，已知既与生殖器官有关，也与非生殖器官有关，而且在大多数情况下，都可以确定诱发因素。我们查阅了文献，仅检索到 19 例从 1936 年至今手术治疗的妊娠孤立性输卵管扭转病例，其中包括我们最近从经验中获得的一例病例。所有病例的临床表现均为下腹部疼痛。右侧占 90%的病例。通常有压痛，但腹膜刺激征伴腹肌紧张或反跳痛则少见。症状有恶心、呕吐、阴道少量出血和尿痛。白细胞增多、CRP 升高和轻度高热等提示坏死的体征并不常见。8 例患者术前进行了超声评估，所有病例均在腹痛同侧检测到附件囊肿。我们最近发表的病例在术前通过多普勒血流超声技术进行了仔细检查，这使得与完全附件扭转的精确鉴别诊断成为可能。这一方面以前从未被考虑过。所有病例的手术方法均显示为急性孤立性输卵管扭转，75%的患者确定了诱发因素。胎儿和母体结局均良好。在妊娠急性腹痛的情况下，如果详细的多普勒血流超声显示正常卵巢和盆腔囊肿，应考虑孤立的输卵管-输卵管旁囊肿扭转，并预见适当的保留卵巢的手术治疗。
