Endometriosis of the appendix presenting like acute appendicitis – a case report

Česká verzia

Authors: M. Černá ¹; P. Novák ¹; V. Třeška ¹; P. Mukenšnabl ²; A. Hudec ³
Authors place of work: 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 the journal: Rozhl. Chir., 2015, roč. 94, č. 5, s. 211-215.
Category: Kazuistika

Summary

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

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