Isolated fallopian tube torsion in a premenarchal girl: a case report of a rare diagnostic challenge

Introduction: Isolated fallopian tube torsion (IFTT) is a rare gynecological emergency. Defined as the twisting of the fallopian tube without ovarian involvement, its incidence is estimated at one in 1.5 million women. Clinical diagnosis is challenging. This case is distinctive because it involves an IFTT in an 11-year-old premenarchal girl with no risk factors. The report underscores the diagnostic pitfall of adnexal imaging showing preserved ovarian blood flow and highlights the need for timely surgical exploration. Case Presentation: We describe an 11-year-old premenarchal girl presenting with 2 days of abdominal pain and fever. Clinical examination revealed diffuse tenderness and a firm mass on rectal exam. Ultrasound showed a tubular adnexal mass with preserved ovarian blood flow. Despite analgesia, symptoms worsened, and emergent laparoscopy followed by laparotomy revealed isolated left fallopian tube torsion with necrosis. A salpingectomy was performed, and pathology confirmed tubal necrosis. The postoperative course was uneventful. Discussion: IFTT is difficult to distinguish clinically from other causes of acute abdomen during the premenarchal age, particularly in the absence of risk factors. Imaging often shows a tubular mass with preserved ovarian flow. Definitive diagnosis is usually made intraoperatively despite imaging. Conservative management may be considered in selected cases. The rarity of the condition and its nonspecific presentation require a high index of suspicion for timely intervention. Conclusion: IFTT, though rare, should be considered in pediatric patients with abdominal pain and adnexal masses. Timely surgical intervention is critical to avoid necrosis and preserve fertility.