GYN #4 Management of Tubal Torsion: When to Consider Salpingectomy with Dr. Lesley Breech

Globalcast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hi everyone, I'm M. Gothi, Research Fellow at Cincinnati Children's Hospital Medical Center. Today, we have a guest from pediatric gynecology department here at Cincinnati Children's, Dr. Leslie Breach. And we will discuss the management of tubal torsion, when to consider salpingectomy with a case scenario. This is a 12-year-old female. She had acute onset of pelvic pain and vomiting. The ultrasound shows a cystic area that is separate from the ovary with blood flow to the right ovary. In the operating room, you find a right adnexal torsion with a healthy appearing ovary. So here, you can see this is the uterus, this is the left fallopian tube. Here is just the right fallopian tube, but you can tell here that there is a twisting, that's sort of the area of torsion. It doesn't look black and ugly like those other images. And this is actually here is the right ovary. Dr. Breach teaches us that that big cystic thing is a paratubular or a wolffian duct remnant. Those are the things that create risk for twisting and they typically happen at puberty. It's really important to ensure that we resect the entire cyst wall. We untwist things, and then we open the mesosalpinx here, and we're going to take the entire cyst wall out. And the most important thing is that you typically see the fallopian tube stretched across it. When doing this kind of resection, it is really important to trace the path of the fallopian tube. This is where we cut into there right here, it's very thin. It's clear, and this is part of the mesosalpinx. And it's not a problem to get into the mesosalpinx, but we just really, really want to be sure we protect the path of the fallopian tube. Don't forget to complete the resection because it will return. And here are our key takeaways. In managing adnexal torsion with a cystic area, like a wolffian duct remnant, it is crucial to accurately diagnose, promptly untwist the adnexa, carefully resect the cyst wall, and ensure the fallopian tube's integrity. Completing resection is vital to prevent recurrence, emphasizing careful surgical technique and awareness of anatomical risks at puberty. Thank you for watching this video. Don't forget to subscribe to the Stay Current MD YouTube channel, follow our social media channels, and download the Stay Current MD app for tons of content in pediatric surgery. Globalcast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.