The fallopian tube develops from the paramesonephric (Mullerian duct) and connects the uterus to the ovary. There are many mild tubal anomalies. While many tubal pathologies are benign and asymptomatic, some may have significant clinical implications if left unidentified or inadequately treated. Clinicians should maintain a broad differential diagnosis when evaluating pediatric and adolescent patients with vague abdominopelvic symptoms. A thorough history and abdominal examination should be performed and may help delineate adnexal etiologies of pain or discomfort. In sexually active adolescents, testing for common sexually transmitted infections such as C. trachomatis and N. gonorrhoeae is recommended, though clinicians should be mindful that a negative infectious workup does not exclude the possibility of an inflammatory fallopian tube pathology. Imaging modalities, such as transabdominal ultrasound and MRI, can be valuable for assessing tubal abnormalities and guiding surgical planning, particularly in premenarchal or never sexually active patients for whom transvaginal ultrasound may be inappropriate. When surgical intervention is indicated, laparoscopy can often provide a safe and effective means of definitive diagnosis and treatment.