AuthorInformation
Raut
DP *, Parulekar SV**, Valvi D***.
(* First Year Resident, ** Professor and Head,
***Assistant Professor, Department of Obstetrics and Gynecology, Seth GS Medical College & KEM
Hospital , Mumbai , India
Abstract
This paper presents
incidental finding of spontaneously detached fimbria of fallopian tube implanted
over the right uterosacral ligament in 32 year old woman during
laparoscopic tubal ligation. This is the first case of this occurrence
in the English world literature. Possible etiology of this condition is
discussed.
Introduction
Fallopian tube is attached
to the cornu of the uterus, one on each side. It lies in a free fold of the
broad ligament called the mesosalpinx. Its lateral or fimbrial end is free,
below which lie the ovarian vessels which pass into the infundibulopelvic
ligament. Detachment of a part or whole of the fallopian tube may be during
embryological development, due to a number of causes in the childhood or adult
life, or as a result of surgery. Except the surgically detached tube, others do
not survive and are resorbed. We present a case in which there was spontaneous
detachment of the fallopian tube, followed by its reimplantation over the
uterosacral ligament of the same side. This is the first case of this
occurrence in the English world literature.
Case Report
A 32 year woman, married
for 12 years, Gravida 4 Para 3 Living 3 came to outpatient department for a
medical termination of pregnancy and a sterilization operation. There was a
history of a failure of male barrier contraception. There was no history any
past medical or surgical illness, abdominal trauma, pelvic tuberculosis or
tuberculosis in the past. She had not undergone any abdominal surgery in the
past. Her three deliveries had been normal and uneventful. No abnormality was
detected on general and systemic examination. Abdominal examination showed
normal findings. Bimanual pelvic examination showed a retroverted uterus of 8
weeks’ size. All fornices were clear. Result of all investigations required for
fitness for anesthesia were normal. A medical termination o pregnancy was done
by rapid cervical dilatation and manual vacuum aspiration. Laparoscopy was
performed to do tubal ligation by silastic band application. The uterine size,
shape and surface were normal. Both
ovaries and the left fallopian tube were normal. The right fallopian
tube ended blindly at the ampullary- infundibular junction. Normal-appearing
fimbria were found attached firmly to the area lateral to the uterine end of
the right uterosacral ligament (figure 1 and 2). No other abnormality detected.
One silastic band was applied to each fallopian tube in the isthmic area. The
right fimbria were left undisturbed. The patient tolerated the procedure well.
Postoperative course is uneventful.
Figure 1. Laparoscopic
view of the pelvic cavity. The fimbria of the right fallopian tube are pointed
out by arrows.
Figure 2. Close up view
of the detached fimbria of the right fallopian tube attached o the pelvic
peritoneum.
Discussion
The commonest cause of
absence of a part or whole of a fallopian tube is iatrogenic – surgical removal
for sterilization or disease like an ectopic pregnancy. Such a condition may
also be due to a tubal ectopic pregnancy which undergoes resorption after local
rupture. Torsion of a fallopian tube may occur due to presence of a
hydrosalpinx, pelvic tumor, pelvic infection, or ectopic pregnancy causing a
hematosalpinx.[1,2,3,4,5,6,7] Sometimes only the fallopian tube is
lost, while at other times the ovary is also lost. The woman may have
experienced acute abdominal pain in the past, which subsided over a few days
with pain killers and observation. In such cases the condition comes to light
much later when a laparoscopy or laparotomy is done for any unrelated
condition. Developmental anomalies of part
of the mesonephric and paramesonephric ducts may be responsible for
congenital absence of a part of the fallopian tube.[8,9,10]
Detachment of a part or whole of the fallopian tube, followed by its
reattachment to another part of the pelvis is not known to occur.
In our case, the right
tube was found to be blocked at the ampullary-infundibular junction. The
fimbria were separate from the fallopian tube and were attached firmly to the
peritoneum lateral to the uterine end of the right uterosacral ligament. The
most likely explanation of this occurrence is that the tube must have undergone
torsion due to a hematosalpinx, and got adherent by its fimbrial end to the
pelvic peritoneum lateral to the uterine end of the right uterosacral ligament,
in order to receive blood supply. The twisted portion must have undergone
necrosis, and the medial part of the tube must have receded to its original
position, while the fimbria remained adherent. We left he spontaneously
detached and reimplanted fimbria were left undisturbed as their removal would
serve no purpose, and leaving them behind would not lead to any complication.
We have presented this
case to make others aware of this condition, so that they can diagnose it when
they encounter such a case themselves.
References
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Citation
Raut DP, Parulekar SV, Valvi D. Wandering Fimbria Of A
Fallopian Tube. JPGO 2015. Volume 2 No. 4. Available from: http://www.jpgo.org/2015/04/wandering-fimbria-of-fallopian-tube.html