Laparoscopic Management of Giant Hydrosalpinx in a Nulliparous Woman.

Abstract

A 26-year-old nulliparous woman with lower abdominal pain, mildly elevated inflammatory markers, normal tumor markers and sonographic findings of an 11.9 × 6.1 cm cystic structure in the right adnexa, was treated with antibiotics for suspected hydrosalpinx. Over two years, subsequent ultrasounds demonstrated progressive cystic enlargement (Fig 1), with dimensions of 11.6 × 26 cm on CT imaging. Although her pain was mild, laparoscopic removal was recommended given the size of the pathology, which the patient consented to. At laparoscopy, a giant hydrosalpinx (Figure 2A), torted 3.5 times at the ampullary region (Figure 2B) was noted. Hydrotubation of the left tube demonstrated substantial resistance to flow (Figure 2C). Following fluid aspiration and detorsion of the right fallopian tube, the serosa was incised using bipolar coagulation to expose the lumen. Careful dissection was performed to separate and excise the serosal layer toward the uterine cornua. Non-absorbable sutures were placed at the interstitial-isthmic junction, and both tubes were subsequently resected [1]. Efforts were made to preserve blood supply between the ovaries and fallopian tubes throughout the procedure. Pathology confirmed bilateral chronic salpingitis, with normal Anti-Müllerian Hormone (AMH) levels. Giant hydrosalpinx is rare and presents substantive diagnostic and management challenges, particularly for young, nulliparous women desiring to conceive. These cystic structures can easily be misdiagnosed as ovarian cysts, making comprehensive imaging essential for accurate diagnosis [2-3]. Although this patient experienced mild symptoms, she developed isolated tubal torsion. Active management of large, persistent, or complex adnexal masses is often warranted and may necessitate surgical intervention. Surgical management focuses on preserving ovarian reserve to improve subsequent birth rates following in vitro fertilization (IVF) [4]. A retrospective clinical study [1] indicates that cornual suturing during salpingectomy may reduce ectopic pregnancy rates from 7.24% to 2.39%. Further validation through randomized controlled trials is necessary.