Isolated tubal torsion in an adolescent after school-based physical activity: a possible trigger
Achmad Kemal Harzif, Intan Indah Permatasari, Putri Nadhira Adinda Adriansyah, Sabihisma Nafsiah Putri Hermawan, Lisa Novianti, Sulung MahardikaBackground:
Isolated tubal torsion (ITT) is a rare gynecologic emergency, representing less than 0.02% of cases of acute pelvic pain. Diagnosing ITT in adolescents can be difficult, particularly when common risk factors are absent or not detected. ITT may also develop around an undiagnosed adnexal mass that becomes symptomatic after a triggering event. Emerging literature suggests that sudden, strenuous physical activity may contribute by changing intra-abdominal dynamics in susceptible patients.
Case presentation:
A 17-year-old female reported 3 months of intermittent lower abdominal pain radiating to the lower back. The pain intensified 1 day before presentation after school physical activities (forward rolls, sit-ups, and push-ups). Prior episodes improved with analgesics, but the current episode did not. She had mild nausea without fever or gastrointestinal, urinary, or gynecological symptoms. Ultrasound revealed a well-defined anechoic adnexal mass approximately 10 × 9 × 9 cm in size. Laparotomy confirmed isolated left tubal torsion with necrosis. Detorsion with tube preservation was considered but was not feasible due to nonviability; therefore, a left salpingectomy was performed with preservation of the ipsilateral ovary.
Results:
Five studies met the criteria for evidence-based ITT case reports, evaluating physical activity as a possible trigger rather than a proven cause. A retrospective cohort study reported that seven out of nine adolescents had recently engaged in sudden-movement activities.
Conclusion:
ITT should be considered in adolescents with acute lower abdominal pain and an adnexal mass lacking a clear ovarian origin. Physical exertion may be a contributing factor, but causality cannot be confirmed from a single case; early surgery remains essential to prevent complications and preserve fertility when possible.