Endometriosis of the Appendix

Endometriosis of the appendix is uncommon

Key Points

Highlights:

• Endometriosis of the appendix is difficult to diagnose perioperatively since these patients present with a range of symptoms including acute appendicitis.

Importance:

• This paper highlights the importance of considering endometriosis in the differential diagnosis for right lower quadrant pain and the importance of considering a history of a gynecologic disease as a clue for the diagnosis.

What’s done here?

• This paper describes a case of a 50-year-old postmenopausal woman with endometriosis in the vermiform appendix presenting as acute appendicitis.

Key Points:

• The patient presented with a sharp, non-radiating, intermittent, moderate pain in the right lower quadrant of the abdomen.
• Her medical history revealed hypertension and adenomyosis with abnormal uterine bleed for which she underwent a total abdominal hysterectomy with bilateral salpingectomy.
• She had no fever and her blood tests demonstrated no significant findings.
• Based on computed tomography findings, doctors suspected appendicitis or an appendiceal neoplasm.
• During surgical exploration, a 1.5-cm nodule was seen on the tip of the appendix and the appendix was removed. Histopathological examination of the appendix showed endometriosis.

Lay Summary

Endometriosis of the gastrointestinal tract is infrequent, and it rarely involves the appendix.

A group of researchers from the United States of America reported a case of a 50-year-old postmenopausal woman with endometriosis in the vermiform appendix presenting as acute appendicitis. Their paper was published in the journal "Cureus".

The patient presented to the emergency department with a three-week history of sharp, non-radiating, intermittent, moderate right lower quadrant abdominal pain. She had a history of hypertension and adenomyosis with abnormal uterine bleed for which she underwent a total abdominal hysterectomy with bilateral salpingectomy. She was afebrile and her blood tests showed no significant findings. On computed tomography, the findings raised concern for appendicitis or an appendiceal neoplasm.

She underwent surgery, a 1.5-cm nodule was seen on the tip of the appendix and had no evidence of pelvic endometriosis. An appendectomy was performed and histopathological examination demonstrated endometriosis.

Since endometriosis and adenomyosis have been described as variants of the same disease process, the authors suggest that the patient’s history of adenomyosis further increased her risk for appendiceal endometriosis.

According to the authors, endometriosis of the appendix is difficult to diagnose perioperatively as these patients present with a range of symptoms. They also stressed that endometriosis should be included in the differential diagnosis for right lower quadrant pain and a history of a gynecologic disease should also be considered.

Research Source: https://pubmed.ncbi.nlm.nih.gov/31737458/