Isolated tubal ischemia due to combined torsion and small bowel volvulus: A rare case report

Abstract

Isolated fallopian tube ischemia is an extremely rare condition, particularly as a consequence of small bowel volvulus. While small bowel volvulus is a well-recognized surgical emergency, its association with secondary gynecological complications remains underreported. We describe an unprecedented case in which postoperative adhesions led to intestinal obstruction and subsequent compression-induced torsion of the fallopian tube, culminating in ischemia and necrosis. A 30-year-old woman, two months post-appendectomy, presented with acute hypogastric pain and vomiting. Abdominopelvic contrast-enhanced computed tomography (CT) revealed a small bowel volvulus with a whirlpool sign, indicative of intestinal torsion. Emergency laparoscopy identified extensive postoperative adhesions causing small bowel obstruction. The mechanical traction exerted by the volvulized bowel led to the torsion and subsequent ischemia of the right fallopian tube. Intraoperative findings included an infarcted, twisted right fallopian tube with a preserved ovary. Surgical intervention involved adhesiolysis, right salpingectomy, and small bowel resection with primary ileal anastomosis. The postoperative course was uneventful, with full recovery at one month. Small bowel volvulus primarily results from congenital or acquired anatomical anomalies, including postoperative adhesions. The pathophysiological mechanism in this case involved secondary bowel volvulus exerting compressive forces on adjacent structures, precipitating fallopian tube torsion. The resultant vascular compromise led to ischemic necrosis, necessitating irreversible tubal resection. While ovarian torsion is a well-characterized entity, isolated tubal torsion remains a diagnostic challenge, particularly in the context of intestinal obstruction. This case highlights the critical interplay between post-surgical adhesions, bowel obstruction, and gynecological ischemic complications. Early surgical intervention is paramount in cases of suspected small bowel volvulus, particularly in post-surgical patients, to mitigate the risk of ischemic complications involving adjacent pelvic structures. This case underscores the need for heightened clinical awareness of fallopian tube torsion as a potential consequence of severe adhesive disease and bowel obstruction. A multidisciplinary approach is essential to ensure prompt diagnosis and optimize surgical outcomes.