Abstract
The proportion of left ovarian endometriotic cysts is significantly higher than the expected 50% (1). This supports the menstrual reflux theory, which holds that the chance of gonadal implantation of regurgitated endometrial cells may be influenced by the anatomical differences between the left and right hemipelvis (1–3). In fact, the presence of the sigmoid colon may create a hidden microenvironment around the left adnexa so that endometrial cells regurgitated through the left tube are less exposed to the peritoneal fluid current (1, 2). The large bowel does not provide the right hemipelvis with this sort of anatomical shelter as the cecum is more cranial.
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