Clinicopathological characteristics and etiological considerations of isolated fallopian tube torsion in pediatric patients: a single center study.

Background: Isolated fallopian tube torsion (IFTT) is an uncommon yet significant differential diagnosis in pediatric female patients presenting with acute abdominal pain. Delayed recognition may lead to tubal necrosis, necessitating salpingectomy and potentially compromising future fertility. Due to its low incidence and nonspecific clinical presentation, IFTT remains underdiagnosed in the pediatric population. This study aims to investigate the preoperative diagnosis and postoperative pathological conditions of IFTT patients. Methods: A retrospective case series was conducted at Beijing Children's Hospital, Capital Medical University, between January 2020 and December 2024. Pediatric female patients under 18 years of age with intraoperatively confirmed IFTT were included. Data on clinical presentation, imaging findings, intraoperative observations, and histopathological results were reviewed. Results: Eighteen patients (mean age: 12.19±1.58 years) met the inclusion criteria. Torsion occurred with equal frequency on the right and left sides (50% each). The predominant symptom was localized lower abdominal pain. Abdominal tenderness was noted in 72% of cases, and 28% presented with associated vomiting. Ultrasonography identified features suggestive of IFTT in 33% of cases, while computed tomography did not provide significant additional diagnostic value. All patients underwent laparoscopic exploration. Intraoperative findings included hydrosalpinx (28%), Müllerian cysts (44%), and para-tubal cysts (28%). Salpingectomy was performed in cases with irreversible ischemic injury. Conclusions: Pediatric IFTT presents with nonspecific symptoms and poses a diagnostic challenge. Imaging modalities demonstrate limited sensitivity, highlighting the importance of early surgical evaluation. Laparoscopy enables prompt diagnosis and supports the possibility of fertility-preserving management. Enhanced clinical awareness of IFTT is essential among pediatric surgeons and gynecologists. Congenital or acquired tubal anomalies, such as cysts or hydrosalpinx, may contribute to the pathogenesis of torsion in this population.