Laparoscopic Management of Isolated Fallopian Tube Torsion in Pregnancy.

Background and Objectives: Isolated fallopian tube torsion (IFTT) is a rare gynecologic emergency that poses a diagnostic challenge during pregnancy due to its nonspecific clinical presentation and overlap with more common abdominal pathologies such as ovarian torsion and appendicitis. We report the case of a 20-year-old primigravid woman at 28 weeks gestation who presented with acute right lower quadrant pain. Diagnostic laparoscopy revealed a necrotic, torsed right fallopian tube associated with a paratubal cyst. We also reviewed the current literature on laparoscopic management of IFTT. Methods: A systematic review following PRISMA guidelines identified seven additional cases of laparoscopic management of IFTT in the second or third trimester, yielding eight cases for analysis. Results: The mean maternal age was 28 years (18-36 years), and the average gestational age was 29 weeks (24-35 weeks). Right-sided abdominal pain was present in 100% of cases, with acute onset in 87.5% and associated nausea and vomiting in 75%. Ultrasonographic imaging consistently identified a pelvic mass with preserved ovarian Doppler flow; MRI was utilized in 75% of cases. The most common preoperative diagnosis was ovarian torsion (62.5%). Entry techniques included Palmer's point (42.9%), Lee-Huang point (42.9%), and one case utilizing umbilical-entry. Salpingectomy was performed in 87.5% of patients due to tubal necrosis. All reported pregnancy outcomes progressed to term. Conclusions: This case and review support laparoscopy as a safe and effective management strategy for IFTT in the second and third trimesters, offering favorable maternal and fetal outcomes when performed with appropriate surgical technique and multidisciplinary coordination.