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
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.
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.
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.
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.
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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