Author Information
Parulekar SV
(Professor and Head, Department of Obstetrics and Hynecology, Seth G S Medical College & K E M Hospital, Mumbai, India.)
Abstract
A fallopian tube can be absent on one side congenitally, or due to resorption of affected tube after torsion. Partial absence may be due to resorption of an ectopic pregnancy in the tube after its rupture. Absence of a fallopian tube along with the ovary of the same side can be congenital, or due to necrosis after a torsion. An unusual case of congenital atresia of a fallopian tube is presented.
Introduction
A fallopian tube may be absent either alone or with ovary of the same side. Both of these conditions can be congenital or acquired due to a number of causes. Usually such an absence shows nothing in the place of the structure which is missing. An unusual case in which a fallopian tube was replaced in its entirety by a fibrous band congenitally is presented.
Case Report
A 23 year old woman, married for 4 years, presented for management of primary infertility. She had regular menses every 28 to 30 days, with moderate flow for 3-4 days and some pelvic pain. Her sexual history was normal. Her past medical and surgical history were not contributory. She had no episode of acute pelvic pain in the past. Her general and systemic examination revealed no abnormality. Her secondary sex characteristics and external genitals were normal. Abdominal examination showed normal findings. A speculum examination showed normal vagina and cervix. A bimanual pelvic examination showed an anteverted, normal sized, mobile uterus and no abnormality. Her husband's semen report was normal. Follicular study showed presence of spontaneous ovulation. Her investigations for fitness for anesthesia showed normal results.
Hysteroscopy and laparoscopy were performed on her under general anesthesia. Hysteroscopy showed normal cervical canal, uterine cavity, endometrium and tubal ostia. Laparoscopy showed normal uterus, ovaries, left fallopian tube, pelvic peritoneum and bowel. The right fallopian tube was replaced by a fibrous band 2-3 mm in diameter, extending from the right cornua to right lateral pelvic wall (figure 1). The patient made an uneventful recovery.
Parulekar SV
(Professor and Head, Department of Obstetrics and Hynecology, Seth G S Medical College & K E M Hospital, Mumbai, India.)
Abstract
A fallopian tube can be absent on one side congenitally, or due to resorption of affected tube after torsion. Partial absence may be due to resorption of an ectopic pregnancy in the tube after its rupture. Absence of a fallopian tube along with the ovary of the same side can be congenital, or due to necrosis after a torsion. An unusual case of congenital atresia of a fallopian tube is presented.
Introduction
A fallopian tube may be absent either alone or with ovary of the same side. Both of these conditions can be congenital or acquired due to a number of causes. Usually such an absence shows nothing in the place of the structure which is missing. An unusual case in which a fallopian tube was replaced in its entirety by a fibrous band congenitally is presented.
Case Report
A 23 year old woman, married for 4 years, presented for management of primary infertility. She had regular menses every 28 to 30 days, with moderate flow for 3-4 days and some pelvic pain. Her sexual history was normal. Her past medical and surgical history were not contributory. She had no episode of acute pelvic pain in the past. Her general and systemic examination revealed no abnormality. Her secondary sex characteristics and external genitals were normal. Abdominal examination showed normal findings. A speculum examination showed normal vagina and cervix. A bimanual pelvic examination showed an anteverted, normal sized, mobile uterus and no abnormality. Her husband's semen report was normal. Follicular study showed presence of spontaneous ovulation. Her investigations for fitness for anesthesia showed normal results.
Hysteroscopy and laparoscopy were performed on her under general anesthesia. Hysteroscopy showed normal cervical canal, uterine cavity, endometrium and tubal ostia. Laparoscopy showed normal uterus, ovaries, left fallopian tube, pelvic peritoneum and bowel. The right fallopian tube was replaced by a fibrous band 2-3 mm in diameter, extending from the right cornua to right lateral pelvic wall (figure 1). The patient made an uneventful recovery.
Figure 1. Laparoscopy findings: RUOL- right uteroovarian ligament, RFT – right fallopian tube (green arrows), RO – right ovary (white arrows).
Discussion
The first case of an absence of a fallopian tube in the world literature was reported by Alexander in 1947.[1] However it was a case of unilateral mesonephric and paramesonephric duct agenesis. There are several reports of unilateral absence of ovary and fallopian tube. Absence of an entire fallopian tube alone is extremely uncommon. Absence of a part of a fallopian tube is more common than total absence.[2, 3] The uterus is the most common site of congenital malformations of the female genital tract. The next common sites is the vagina. The fallopian tube alone is a rare site, though it can be absent in cases of unilateral mullerian agenesis, in which the uterus on the same side is also not developed (unicornuate uterus). Unilateral ovarian and fallopian tube agenesis is believed to occur in 1:11240 cases. [4] When both the ovary and fallopian tube are absent on one side, the most likely cause is torsion of the adnexal structures, the symptoms caused by which may or may not be remembered by the patient. The tube and ovary undergo ischemic necrosis and get resorbed. Less commonly it is due to a congenital malformation. [5, 6, 7] The presence of ovarian and tubal remnants in the peritoneal cavity in such a case supports the theory of torsion being responsible for such cases.[8] Congenital malformations of the fallopian tub include accessory ostia, duplication of the entire tube, diverticulum formation and partial or complete absence of the fallopian tube.[9, 10]
Usually the condition is diagnosed incidentally during a laparoscopy or laparotomy which is being done for an unrelated condition. Pednekar and Parulekar reported unilateral absence of midportion of the left fallopian tube at the time of a cesarean section in a multiparous patient.[2] Partial absence of the tube was reported in 18 cases by Nawroth et al.[11] Total absence of a fallopian tube is even rarer. Paternoster et al reported two such cases. [12] Paterson and Chan reported a curious case with absence of proximal part of the left fallopian tube and separation of the distal end into 3 parts. [13]
The case presented here was extremely unusual in that there was a fibrotic atresia of the entire fallopian tube. Such an occurrence has not been described in the literature. It was asymptomatic and was diagnosed coincidentally. Since the woman had both ovaries and a normal other fallopian tube, her reproductive potential was not affected by the condition. It is reported only for the sake of making the medical community aware of such a condition. It has no treatment.
Acknowledgment
I thank Dr Neha Mathews for taking operative photograph.
References
Discussion
The first case of an absence of a fallopian tube in the world literature was reported by Alexander in 1947.[1] However it was a case of unilateral mesonephric and paramesonephric duct agenesis. There are several reports of unilateral absence of ovary and fallopian tube. Absence of an entire fallopian tube alone is extremely uncommon. Absence of a part of a fallopian tube is more common than total absence.[2, 3] The uterus is the most common site of congenital malformations of the female genital tract. The next common sites is the vagina. The fallopian tube alone is a rare site, though it can be absent in cases of unilateral mullerian agenesis, in which the uterus on the same side is also not developed (unicornuate uterus). Unilateral ovarian and fallopian tube agenesis is believed to occur in 1:11240 cases. [4] When both the ovary and fallopian tube are absent on one side, the most likely cause is torsion of the adnexal structures, the symptoms caused by which may or may not be remembered by the patient. The tube and ovary undergo ischemic necrosis and get resorbed. Less commonly it is due to a congenital malformation. [5, 6, 7] The presence of ovarian and tubal remnants in the peritoneal cavity in such a case supports the theory of torsion being responsible for such cases.[8] Congenital malformations of the fallopian tub include accessory ostia, duplication of the entire tube, diverticulum formation and partial or complete absence of the fallopian tube.[9, 10]
Usually the condition is diagnosed incidentally during a laparoscopy or laparotomy which is being done for an unrelated condition. Pednekar and Parulekar reported unilateral absence of midportion of the left fallopian tube at the time of a cesarean section in a multiparous patient.[2] Partial absence of the tube was reported in 18 cases by Nawroth et al.[11] Total absence of a fallopian tube is even rarer. Paternoster et al reported two such cases. [12] Paterson and Chan reported a curious case with absence of proximal part of the left fallopian tube and separation of the distal end into 3 parts. [13]
The case presented here was extremely unusual in that there was a fibrotic atresia of the entire fallopian tube. Such an occurrence has not been described in the literature. It was asymptomatic and was diagnosed coincidentally. Since the woman had both ovaries and a normal other fallopian tube, her reproductive potential was not affected by the condition. It is reported only for the sake of making the medical community aware of such a condition. It has no treatment.
Acknowledgment
I thank Dr Neha Mathews for taking operative photograph.
References
- Alexander HD. True unicornuate uterus and total absence of left broad ligament, round ligament, salpinx, ovary, kidney and ureter. Can Med Assoc J. 1947 May; 56(5):539.
- Pednekar R, Parulekar SV. Unilateral Segmental Absence Of Fallopian Tube. JPGO 2015. Volume 3 No. 6. Available from: http://www.jpgo.org/2016/06/unilateral-segmental-absence-of.html
- Yazawa H, Yabe M, Endo S, Hayashi S.A Case Of Congenital Unilateral Partial Absence Of Fallopian Tube. Fukushima Journal Of Medical Science. 2010;56:44-49.
- Rapisarda G, Pappalardo EM, Arancio A, La Greca M. Unilateral ovarian and fallopian tube agenesis. Arch Gynecol Obstet. 2009 Nov; 280(5):849-50.
- Sirisena LA. Unexplained absence of an ovary and uterine tube. Postgrad Med J. 1978;54:423–424.
- Eustace DL. Congenital absence of fallopian tube and ovary. Eur J Obstet Gynecol Reprod Biol. 1992;46:157–159.
- Vaiarelli A, Luk J, Patrizio P. Ectopic pregnancy after IVF in a patient with unilateral agenesis of the fallopian tube and ovary and with endometriosis: search of the literature for these associations. J Assist Reprod Genet. 2012;29:901–904.
- Uckuyu A, Ozcimen EE, Sevinc Ciftci FC. Unilateral congenital ovarian and partial tubal absence: report of four cases with review of literature. Fertil Steril. 2009;91:936 e5–e8.
- Beyth Y, Kopolovic J. Accessory tubes, a possible contributing factor in fertility. Fertile Sterile. 1982;38:382-3.
- Daw E. Duplication of uterine tube. Obstet Gynecol. 1973;42:137-8.
- Nawroth F, Nugent W, Ludwig M. Congenital partial atresia of fallopian tube. Reprod Biomed Online. 2006;12:205-8.
- Paternoster DM, Costantini W, Uglietti A, Vasile C, Bocconi L. Congenital or torsion-induced absence of Fallopian tubes. Two case reports. Minerva Ginecologica 1998, 50(5):191-194.
- Paterson PJ, Chan CLK. Congenital Absence of Fallopian Tube Segments. ANZJPG 1985 Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1479-828X.1985.tb00626.x#
Citation
Parulekar SV. Unilateral Fibrotic Atresia Of Fallopian Tube. JPGO 2018. Vol 5 No. 11. Available from: https://www.jpgo.org/2018/11/unilateral-fibrotic-atresia-of.html
Parulekar SV. Unilateral Fibrotic Atresia Of Fallopian Tube. JPGO 2018. Vol 5 No. 11. Available from: https://www.jpgo.org/2018/11/unilateral-fibrotic-atresia-of.html