Relation between anatomical courses of the intramural portions of the uterine tubes and pelvic endometriosis

OBJECTIVE: Endometriosis may originate from implants of endometrium due to retrograde flow of menstrual blood. The flow may be stimulated by anatomical anomalies of uterine tubes or uterus. The aim of the study was to find links between anatomical courses of the intramural portions of the uterine tubes and endometriosis. DESIGN: Retrospective comparative study. SETTING: Academic hospital. PATIENT(S): Women (n = 227) operated on because of various gynecological indications. INTERVENTION(S): Total or subtotal abdominal hysterectomies. MAIN OUTCOME MEASURE(S): Pathological reports correlated with courses of the intramural parts of uterine tubes. To evaluate the intramural courses of uterine tubes, specimens were injected with barium sulfate and x-rayed. RESULT(S): The intramural portions were categorized into three patterns: straight, curved, or tortuous. Logistic regression identified the course of the intramural portion of the uterine tubes and the parity to be associated with endometriosis. Endometriosis was more frequent in women with straight courses and was infrequent in women with tortuous ones. CONCLUSION(S): We suggest that a tortuous course of the intramural portion of the uterine tubes constitutes a normal anatomical finding. It controls the retrograde flow of blood during menstruation and limits the possibility of developing endometriosis. Straight or curved intramural portions represent an anatomical abnormality that may predispose women to endometriosis.