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ABSTRACT Isolated fallopian tube torsion requiring surgical intervention in pregnancy is rare. Herein is reported a case of fallopian tube
torsion that was managed laparoscopically at 35 weeks of gestation. Journal of Minimally Invasive Gynecology (2011) 18,
390–392 Ó 2011 AAGL. All rights reserved.
During pregnancy, laparoscopy is comparable to laparot- that time, she had no symptoms. She came to the obstetric
omy in terms of safety [1,2]. Laparoscopy has the added service at 35 weeks 4 days with symptoms of acute-onset
advantages of decreased length of stay, less postoperative right lower quadrant pain 8/10, nausea and vomiting, and
pain, quicker return to ambulation, and a smaller chance of uterine contractions. At examination, she was afebrile,
wound infection and incisional hernia [3]. The most com- with normal vital signs. Fundal height was 32 cm. Physical
mon nonobstetric surgery performed in pregnancy is appen- examination of the abdomen revealed positive bowel sounds
dectomy, and in many hospitals the laparoscopic approach is and tenderness over the right lower quadrant and suprapubic
becoming the standard [4]. Ovarian torsion is increasingly area without evidence of peritoneal symptoms. The patient
more often managed laparoscopically [5]. Data from case re- was admitted for observation and given intravenous pain
ports and series list the incidence of ovarian torsion in preg- medication. She experienced contractions regularly without
nancy as from less than 1% to 22% [6]. Fallopian tube cervical change, and the fetal heart rate tracing was within
torsion due to a paraovarian or paratubal cyst in pregnancy normal limits. Complete white blood cell count, electrolyte
is even less common, with only case reports in the literature concentrations, and urinalysis were within normal limits.
[7]. Herein is described a successful case of laparoscopic Ultrasonography performed to evaluate the right adnexa
drainage of a paratubal cyst, with untwisting of the fallopian and appendix revealed a 9.2 ! 5.8 ! 4.2-cm right adnexal
tube, at 35 weeks of gestation. cyst, 3.1 ! 1.6 ! 2.1-cm right ovary, and normal duplex
Doppler flow (Fig. 1). It could not be determined whether
the mass was arising from or adjacent to the right ovary,
Case Report and the appendix could not be visualized. No free peritoneal
A 33-year-old woman, gravida 5, para 4, was noted to fluid was visualized.
have a simple-appearing right ovarian cyst measuring 6.7 Because of concern for ovarian torsion, surgical manage-
! 6.3 ! 4.6 cm when she was evaluated at ultrasound at ment was recommended. The patient was counseled about
30 weeks of gestation due to size and date discrepancy. At the diagnosis and treatment options, and informed consent
was obtained. Laparoscopy was performed with the patient
under general endotracheal anesthesia. A single dose of
The authors have no commercial, proprietary, or financial interest in the
ephedrine, 20 mg IV, was required after induction to main-
products or companies described in this article.
Corresponding author: Charles C. Kilpatrick, MD, Department of Obstetrics tain blood pressure within 20% of baseline, and maternal
and Gynecology, University of Texas Health Science Center at Houston, end-tidal carbon dioxide (CO2) was maintained at 32 to 34
Lyndon Baines Johnson Hospital, 5656 Kelley St, Houston TX, 77026. mm Hg throughout the procedure. In the left upper quadrant,
E-mail: [email protected] inferior to the costal margin, superior to the gravid uterus,
Submitted December 15, 2010. Accepted for publication January 26, 2011. and medial to the Palmer point, a Veress needle was intro-
Available at www.sciencedirect.com and www.jmig.org duced, and intraperitoneal placement was confirmed with
1553-4650/$ - see front matter Ó 2011 AAGL. All rights reserved.
doi:10.1016/j.jmig.2011.01.017
Chohan et al. Laparoscopic Paratubal Cyst Management at 35 Weeks’ Gestation 391
Fig. 1 Fig. 3
Ultrasound image of right paratubal cyst abutting the right ovary. Laparoscopic view of right fallopian tube after untwisting.