Hydrosalpinx is an accumulation of serous fluid in the lumen of the ampulla consequent to a distal occlusion. It is a rare cause of abdominal pain in children, having a different etiology than adults. Hydrosalpinx has a nonspecific clinical course and ultrasound may identify a suspicious lesion, but laparoscopy is necessary for a final diagnosis. Surgical treatment of choice is usually salpingectomy, but this is associated with potentially reduced fertility. Neo-salpingostomy is an option to conserve the fallopian tube and protect the reproductive potential of pediatric patients. We present a case of an 11-year-old girl, with a 1-year history of episodic right lower quadrant abdominal pain. She consulted to the ER during an episode of acute abdominal pain, and a pelvic ultrasound showed two cystic lesions on the right ovary: one complex and one simple cyst. The patient was stable, and there were no acute abdominal signs. Tumor markers were negative. Exploratory laparoscopy was performed to study and excise the complex ovarian cyst. Torsion of the right fallopian tube was found, with an associated hydrosalpinx of clear liquid content and a simple ovarian cyst on the same side, with no evidence of adnexal necrosis. The procedure included drainage of hydrosalpinx and the ovarian cyst, and a neo-salpingostomy. The hydrosalpinx explains the prolonged symptoms of recurrent abdominal pain in this patient, eventually causing torsion of the fallopian tube presenting with acute abdominal pain. Neo-salpingostomy is a plausible treatment in the management of hydrosalpinx of pediatric patients to preserve their reproductive potential.