Isolated fallopian tube torsion (IFTT) is a rare cause of acute pelvic pain, especially in pediatric patients. It is often misdiagnosed due to non-specific clinical and imaging findings. We report a 12-year-old girl who presented with an acute onset of left lower abdominal pain and vomiting. Laboratory investigations, including tumor markers, were normal. Imaging studies (ultrasound and magnetic resonance imaging (MRI)) demonstrated a normal-appearing ovary with an adjacent heterogeneous adnexal mass. However, MRI findings raised suspicion for adnexal torsion. Emergency laparoscopy confirmed a 540-degree torsion of the left fallopian tube secondary to a paratubal cyst. The ovary was unaffected and appeared grossly normal. IFTT should be considered in adolescent females with pelvic pain and normal-appearing ovaries on imaging. Early surgical intervention is crucial for preserving fertility and preventing complications.

Thuraya Al Kindi graduated from the College of Medicine, Sultan Qaboos University, in 2022. She completed her internship training at tertiary care hospitals in Muscat and is currently enrolled in the Radiology Residency Program at the Oman Medical Specialty Board.