To determine an association between adnexal torsion, endometriosis, and other risk factors for pelvic adhesions

Design:

Retrospective case control study

Setting:

Academic, tertiary-care medical center and two affiliated hospitals

Patients or Participants:

Female patients undergoing emergent laparoscopic surgery for suspected adnexal torsion from January 2014 to August 2023.

Interventions:

Variables examined included history of endometriosis, pain duration, ultrasound findings, prior surgery, intraoperative findings, and pathology.

Measurements and Main Results:

138 patients underwent surgery for suspected adnexal torsion. 118 (85.5%) were found to have torsion while 20 (14.5%) did not. Preoperative history of endometriosis was associated with lower torsion risk (OR 0.30, 95% CI [0.11-0.77]). 0% of the torsion cases were found to have an endometrioma on pathology compared to 11.9% (n=5) of the non-torsion cases (p=.001). Intraoperative finding suggestive of endometriosis in the torsion cohort were Stage I or II without ovarian involvement. 23.8% (n=10) of cases without torsion either had a pre op or post operative diagnosis of endometriosis compared to 8.5% (n=10) in the torsion group, p=0.01. Intraoperative dense pelvic adhesions were linked to lower torsion risk (OR 0.06, 95% CI 0.02-0.17). Neither prior adnexal surgery or hysterectomy decreased torsion risk.

Conclusion:

In this study, a pre-operative diagnosis of endometriosis was associated with lower risk of having adnexal torsion. Furthermore, no case of adnexal torsion was found to have an endometrioma. Any post-operative diagnosis of endometriosis in cases of adnexal torsion did not involve the ovaries. The presence of dense pelvic adhesions also had less association with adnexal torsion. Larger multi-center studies are needed to confirm these findings.