Introduction: Isolated fallopian tube torsion is rare and can be challenging to diagnose given its non-specific presentation. Although this condition is often associated with older women of reproductive age, young adolescents are not spared. Despite advances in imaging, the diagnosis is almost exclusively made by direct visualization during surgery, as occurred with this case.

Clinical Findings: The patient’s initial presentation mimicked appendicitis, and subsequent imaging led us to prioritize diagnoses other than fallopian tube torsion. Although ovarian torsion was high on the differential, we did not make the correct diagnosis—isolated left fallopian tube torsion—until direct visualization in the operating room.

Clinical Course: Due to the extent of necrosis, the fallopian tube could not be salvaged, and the patient underwent an uncomplicated unilateral salpingectomy. Her recovery was uncomplicated, and her future fertility outcomes are unknown.

Conclusions: In hindsight, earlier surgical exploration could have led to a timelier diagnosis and preservation of the affected fallopian tube.