Endometriosis of the appendix presenting like acute appendicitis – a case report
Authors:
M. Černá 1; P. Novák 1; V. Třeška 1; P. Mukenšnabl 2; A. Hudec 3
Authors‘ workplace:
Chirurgická klinika FN a LF UK v Plzni, přednosta: prof. MUDr. V. Třeška, DrSc.
1; Šiklův ústav patologie FN a LF UK v Plzni, přednosta: prof. MUDr. M. Michal
2; Gynekologicko-porodnická klinika FN a LF UK v Plzni, přednosta: doc. MUDr. Z. Novotný, CSc.
3
Published in:
Rozhl. Chir., 2015, roč. 94, č. 5, s. 211-215.
Category:
Case Report
Overview
Introduction:
In general, pain in the lower right abdomen is the most frequent reason for hospital surgical admissions, acute appendicitis representing the most common cause of operation for acute abdomen. Timely appendectomy remains the only treatment in the early stages of inflammation and is usually uncomplicated, requiring only a short hospital stay. A differential diagnostic analysis necessitates a search for other, particularly long-term symptoms that might be driven to the background in cases of acute exacerbation.
Case report:
The case report presents a 38-year-old female patient who was admitted for lower right abdominal pain. Clinical examination and a blood test both suggested typical acute uncomplicated appendicitis, and therefore the patient underwent appendectomy. Haemorrhagic peritoneal fluid and nodularity of the appendix not typical for appendicitis was found. Oedema of the terminal ileum and a right adnexal tumour were a surprising finding. A more extensive surgical procedure involving ileocaecal resection and right-side adnexectomy was finally performed with regard to the intraoperative finding. The definitive diagnosis of appendiceal endometriosis, endometrial mass in the terminal intestine and ovarian endometriosis was established by histological evaluation. Long-term follow-up revealed microadenocarcinoma of cervix uteri.
Conclusion:
It is generally very difficult to confirm appendiceal endometriosis before operation, and revealing primary appendiceal endometriosis is virtually impossible. It is advisable to consider endometriosis in fertile women with chronic abdominal pain of unclear aetiology and gynaecological symptoms in their personal history. The best diagnostic and therapeutic method, respectively, is laparoscopy enabling exploration of the entire peritoneal cavity including the minor pelvis, and performing appendectomy as well as excision of suspicious endometrial lesions. The definitive diagnosis is usually established by histopathological evaluation. Gynaecological assessment and follow-up is highly recommended after surgery.
Key words:
lower right abdominal pain – appendiceal endometriosis – unusual acute abdomen – acute appendicitis – endometriosis of terminal ileum
Sources
1. Suchý T, Štěpán J. Extragenitální endometrióza jako předmět zájmu chirurga. Rozhl Chir 2004;83:239−41.
2. Emre A, Akbulut S, Yilmaz M, et al. An unusual cause of acute appendicitis: Appendiceal endometriosis. Int J Surg Case Rep 2013;4:54−7.
3. Saleem A, Navarro P, Munson JL, et al. Endometriosis of the appendix: Report of three cases. International Journal of Surgery Case Reports 2011;2:16−9.
4. Douglas C, Rotimi O. Extragenital endometriosis: a clinicopathological review of a hospital experience with case illustrations. J Obstet Gynaecol 2004;24:445−54.
5. Koutsourelakis I, Markakis H, Koulas S, et al. Ileocolic intussusception Due to Endometriosis. JSLS 2007; 11:131−5.
6. Maltz C, Sonoda T, Yantiss RK. Endometriosis causing ileocecal intussusception. Gastrointest Endosc 2008;67:352−3.
7. Unalp HR, Akguner T, Yavuzcan A, et al. Acute small bowel obstruction due to ileal endometriosis: a case report and review of the most recent literature. Vojnosanit Pregl 2012;69:1013−6.
8. Uwaezuoke S, Udoye E, Etebu E. Endometriosis of the appendix presenting as acute appendicitis: A case report and literature review. Ethiop J Health Sci 2013;23:69−72.
9. Uncu H, Taner D. Appendiceal endometriosis: two case reports. Arch Gynecol Obstet 2008;278:273−5.
10. Von Rokitansky C. Über Uterusdrüsenneubildung in uterus- und Ovarial-sarcomen. Z Ges Aerzte Wien 1860;16: 577−81.
11. Mittal VK, Choudhury SP, Cortez JA. Endometriosis of the appendix presenting as acute appendicitis. Am J Surg. 1981;142:519−21.
12. Uohara JK, Kobara TY. Endometriosis of the appendix. Am J Obstet Gynecol 1975;121:423−6.
13. Langman J, Rowland R, Vernon-Roberts B. Endometriosis of the appendix. Br J Surg 1981;68:121−4.
14. Gustofson RL, Kim N, Liu S, et al. Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril 2006;86:298−303.
15. Levine CD, Aizenstein O, Wachsberg RH. Pitfalls in the CT diagnosis of appendicitis. Br J Radiol 2004;77:792−9.
16. Laskou S, Papavramidis TS, Cheva A, et al. Acute appendicitis caused by endometriosis: a case report. J Med Case Reports. 2011;5:144.
17. 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;25:445−54.
18. Gini PC, Chukudebelu WO, Onuigbo WI. Perforation of the appendix during pregnancy: a rare complication of endometriosis. Br J Obstet Gynaecol 1981;88:456−8.
19. Nakatani Y, Hara M, Misugi K, et al. Appendiceal endometriosis in pregnancy. Report of a case with perforation and review of the literature. Acta Pathol Jpn 1987;37:1685−90.
20. Toru H, Koichi Y, Kazahiro M. Endometriosis of the appendix resulting in perforated appendicitis. Case Rep Gastroenterol 2007;1:27−31.
21. Hasegawa T, Yoshida K, Matsui K. Endometriosis of the appendix resulting in perforated appendicitis. Case rep gastroenterol 2007;1: 27−31.
22. Matsuura K, Ohtake H, Katabuchi H, et al. 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.
23. Ichimiya M, Hirota T, Muto M. Intralymphatic embolic cells with cutaneous endometriosis in the umbilicus. J Dermatol 1998;25:333−6.
24. Seli E, Berkkanoglu M, Arici A. Pathogenesis of endometriosis. Obstet Gynecol Clin North Am 2003;30:41−61.
25. Papavramidis TS, Sapalidis K, Michalopoulos N, et al. Spontaneous abdominal wall endometriosis: a case report. Acta Chir Belg 2009;109:778−81.
26. Yetkin G, Uludag M, Citgez B, et al. Endometriosis of the appendix presenting as acute appendicitis. BMJ Case Reports 2009; Published online doi: 10.1136/bcr.04.2009.1820.
27. Yoon J, Lee YS, Chang HS, et al. Endometriosis of the appendix. Ann Surg Treat Res Sep 2014; 87:144−7.
28. Douglas C, Rotimi O. Extragenital endometriosis: a clinicopathological review of a Glasgow hospital experience with case illustrations. J Obstet Gynaecol 2004;24:804−8.
29. Astroza G, Faundes V, Nanjarí R, et al. Appendiceal endometriosis differentially diagnosed from acute appendicitis. Chin Med J 2010;123:1610−1.
30. Idetsu A, Ojima H, Saito K, et al. Laparoscopic appendectomy for appendiceal endometriosis presenting as acute appendicitis: report of a case. Surg Today 2007;37:510−3.
31. Berker B, Lashay N, Davarpanah R, et al. Laparoscopic appendectomy in patients with endometriosis. J Minim Invasive Gynecol 2005;12:206−9.
32. Tuten A, Kucur M, Imamoglu M, et al. Copeptin is associated with the severity of endometriosis. Arch Gynecol Obstet 2014;290:75−82.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2015 Issue 5
Most read in this issue
- Pancreatic metastases − diagnosis, radical surgery, complications and survival
- Intestinal volvulus caused by the ingestion of magnet balls: unexpected risk in children
- Endometriosis of the appendix presenting like acute appendicitis – a case report
- Femoropopliteal deep vein thrombosis and popliteal artery pseudoaneurysm as a complication of multiple hereditary osteochondromatosis