Isolated torsion of the fallopian tube in pre menarcheal girls is very rare. However correct diagnosis and treatment are needed in order to optimize salvage of fallopian tube. While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone, first described in 1890(Sutton, 1890) remained a rare occurrence with an incidence of 1 in 1.5million women(Hansen, 1970). It most frequently during menstruating years, but also has been reported in pre and pause menopausal women. It has also been reported in infants and pre menarcheal girls. Many etiologies for tubal torsion have been suggested including hydrosalpinx, tubal carcinoma, prior tubal ligation(Krissi et al 1997), ovarian and paraovarian masses, pregnancy, hydatid of Morgagni and peristaltic abnormalities. The condition may also occur in pregnancy, labour and pre menstrual period.
Diagnosis of this condition is often delayed because of the rarity of its occurrence and prolonged investigations to rule out more common causes of acute abdominal pain.

Case Report:
13year old Miss. X, who has not attained menarche, was referred to our centre with history of lower abdominal pain of two days duration and with an ultrasound scan report showing right ovarian cyst of 5x3cm, for diagnostic laparoscopy. She has no significant past medical and surgical illnesses. She has not attained menarche. On examination there was no pallor, vital signs were stable, has normal secondary sexual characters, systemic examination was normal. Abdominal examination revealed no palpable mass or tenderness. Transabdominal scan showed uterus to be 3.5x2.2cm, endometrium 3mm, right adnexal mass of 4.5x4cm seen, which is anechoic with fine basal echoes. Left ovary was not seen. Ultrasonic diagnosis of right ovarian cyst was made and laparoscopy was decided. At laparoscopy the peritoneum, appendix, pouch of Douglas and upper abdomen were normal. Uterus was normal looking, both ovaries normal. Right tube was twisted thrice along with a paratubal cyst of 4cm. The cystic mass appeared bluish. Untwisting of the right tube , right paratubal cystectomy done, edges reformed. Intraoperative and post operative period were uneventful. The patient was discharged was discharged the next day. HPE diagnosis was consistent with paratubal cyst(twisted).


Conclusion:
Isolated fallopian tube torsion is rare entity especially in pre menarcheal age. At first episode of torsion of fallopian tube, tubal preservation must be the rule unless the tube is totally necrotic. A timely diagnosis and surgical intervention may allow preservation of the tube.

Objective:Laparoscopy is used for management of abdominal trauma (blunt as well as penetrating) hence minimizing the open laparotomies.

Methods:180 laparotomies for abdominal trauma were performed at Jabalpur Hospital from Dec.1999 to may 2005.Out of these 27 were managed laparoscopically.All of these were subjected to baseline investigations.The selected patients were subjected to diagnostic laparoscopy.18 of these
had blunt trauma and 9 had penetrating injuries.
In blunt trauma group 9 patients had to be converted to open surgery and rest 9 underwent laparoscopic management.
In penetrating trauma group only 2 cases needed open surgery and rest 7 were managed laparoscopically.

Results: Laparoscopically managed patients had no missed injuries and no deaths or significant complications.

Conclusions:Selected patients of abdominal trauma managed
laparoscopicaly showed quick recovery and minimizing the expenditure and more so of loss of man hour.