Ann Surg Treat Res.  2014 Sep;87(3):144-147. 10.4174/astr.2014.87.3.144.

Endometriosis of the appendix

• Yoon J
• Lee YS
• Chang HS
• Park CS

• KMID: 1908485
• DOI: http://doi.org/10.4174/astr.2014.87.3.144

Abstract

PURPOSE
Endometriosis is defined as functioning endometrial tissue outside of the uterus. Endometriosis of the appendix is uncommon. Its clinical presentation varies from asymptomatic to acute abdominal pain. The aims of this study were to describe our experience of managing patients with appendiceal endometriosis and to review the clinical characteristics of this medical condition.
METHODS
Five cases of appendiceal endometriosis diagnosed between January 2007 and December 2012 were retrospectively reviewed. Patients treated for intra-abdominal endometriosis were excluded.
RESULTS
The mean age at diagnosis was 33.8 years old. One patient was in the second trimester of pregnancy. Two patients were asymptomatic. Three patients had clinical symptoms including two with acute pain in the right lower quadrant and one with abdominal discomfort. Four patients showed appendiceal abnormalities in imaging studies including two cases of suspected mucocele and two cases of appendiceal infection. There were no suspicions of endometriosis of the appendix based on preoperative imaging studies. Three patients underwent appendectomy due to clinical symptoms, and two underwent incidental appendectomy combined with another operation. None of the patients received adjuvant therapy.
CONCLUSION
Appendiceal endometriosis should be included in the differential diagnosis for acute abdominal pain, especially when women of childbearing age present with clinical symptoms of acute appendicitis.

Keyword

Appendix; Appendicitis; Endometriosis; Abdominal pain; Acute abdomen

MeSH Terms

Abdomen, Acute
Abdominal Pain
Acute Pain
Appendectomy
Appendicitis
Appendix*
Diagnosis
Diagnosis, Differential
Endometriosis*
Female
Humans
Mucocele
Pregnancy
Pregnancy Trimester, Second
Retrospective Studies
Uterus

Reference

1. Hwang BJ, Jafferjee N, Paniz-Mondolfi A, Baer J, Cooke K, Frager D. Nongynecological endometriosis presenting as an acute abdomen. Emerg Radiol. 2012; 19:463–471.

2. Von Rokitansky C. Über uterusdrüsenneubildung in uterus- und ovarial-sarcomen. Z Ges Aerzte Wien. 1860; 16:577–581.

3. Uncu H, Taner D. Appendiceal endometriosis: two case reports. Arch Gynecol Obstet. 2008; 278:273–275.

4. Mittal VK, Choudhury SP, Cortez JA. Endometriosis of the appendix presenting as acute appendicitis. Am J Surg. 1981; 142:519–521.

5. Gustofson RL, Kim N, Liu S, Stratton P. Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril. 2006; 86:298–303.

6. Papavramidis TS, Sapalidis K, Michalopoulos N, Karayanopoulou G, Raptou G, Tzioufa V, et al. Spontaneous abdominal wall endometriosis: a case report. Acta Chir Belg. 2009; 109:778–781.

7. Seli E, Berkkanoglu M, Arici A. Pathogenesis of endometriosis. Obstet Gynecol Clin North Am. 2003; 30:41–61.

8. Ichimiya M, Hirota T, Muto M. Intralymphatic embolic cells with cutaneous endometriosis in the umbilicus. J Dermatol. 1998; 25:333–336.

9. Matsuura K, Ohtake H, Katabuchi H, Okamura H. Coelomic metaplasia theory of endometriosis: evidence from in vivo studies and an in vitro experimental model. Gynecol Obstet Invest. 1999; 47:Suppl 1. 18–20.

10. Yantiss RK, Clement PB, Young RH. Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol. 2001; 25:445–454.

11. Levine CD, Aizenstein O, Wachsberg RH. Pitfalls in the CT diagnosis of appendicitis. Br J Radiol. 2004; 77:792–799.

12. Douglas C, Rotimi O. Extragenital endometriosis: a clinicopathological review of a Glasgow hospital experience with case illustrations. J Obstet Gynaecol. 2004; 24:804–808.

13. Idetsu A, Ojima H, Saito K, Yamauchi H, Yamaki E, Hosouchi Y, et al. Laparoscopic appendectomy for appendiceal endometriosis presenting as acute appendicitis: report of a case. Surg Today. 2007; 37:510–513.