Endometriosis and the Risk of Adnexal Torsion

Abstract

Study Objective:

This study aims to determine if the presence of endometriosis decreases the probability of adnexal torsion. We hypothesize that the presence of endometriosis is associated with a lower risk of ovarian torsion.

Methods:

A retrospective case–control study was performed. Study population included patients who underwent emergent surgery for suspected adnexal torsion from January 2014 to August 2023. The medical record was reviewed to obtain demographic information, preoperative symptoms, patient history, and intraoperative findings. Pathology results were reviewed when applicable. A convenience sample was utilized due to limited number of cases. A post hoc power analysis was calculated.

Results:

A total of 160 patients underwent surgery for suspected adnexal torsion, with 118 (73.8%) found to have torsion, while 42 (26.2%) did not. Preoperative history of endometriosis was associated with lower torsion risk (odds ratio [OR] = 0.30, 95% confidence interval [CI]: 0.11–0.77). Endometriomas were not found in any of the torsion cases compared with 5 (11.9%) of the nontorsion cases (p = 0.001). Intraoperative findings suggestive of endometriosis in the torsion group were superficial without ovarian involvement. Adhesions between the adnexa and the pelvic side wall were linked to lower torsion risk (OR = 0.06, 95% CI: 0.02–0.17).

Conclusion:

A preoperative diagnosis of endometriosis was associated with lower odds of having adnexal torsion. Furthermore, five (3%) endometriomas were found in total, all in nontorsion patients. Our data show that patients with endometriosis have a lower risk of adnexal torsion, particularly if they have ovarian involvement. The presence of pelvic adhesions between the adnexa and pelvic side wall was also associated with a lower risk of adnexal torsion.