An unusual cause of acute appendicitis: Appendiceal endometriosis

CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 4 (2013) 54–57

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An unusual cause of acute appendicitis: Appendiceal endometriosis Arif Emre a , Sami Akbulut b,∗ , Mehmet Yilmaz b , Zehra Bozdag c a b c

Department of Surgery, Malatya State Hospital, 44300 Malatya, Turkey Department of Surgery, Inonu University Faculty of Medicine, 44280 Malatya, Turkey Department of Pathology, Malatya State Hospital, 44300 Malatya, Turkey

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Article history: Received 8 May 2012 Received in revised form 17 July 2012 Accepted 29 July 2012 Available online 19 September 2012 Keywords: Appendicitis Endometriosis Unusual presentation

a b s t r a c t INTRODUCTION: While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Appendiceal involvement may present as acute appendicitis and definitive diagnosis is made by only postoperative histological examination. PRESENTATION OF CASE: In this study, we present two cases of female patients who underwent an appendectomy presumed diagnosis as acute appendicitis, and a histopathological examination of the retrieved specimen revealed appendiceal endometriosis. DISCUSSION: Endometriosis is defined as the presence of ectopic endometrial tissue outside the lining of the uterine cavity. Gastrointestinal endometriosis is observed in 3–37% of all endometriosis cases, whereas appendiceal endometriosis accounts for only about 3% of gastrointestinal endometriosis. Appendiceal endometriosis is usually asymptomatic, although it sometimes causes abdominal cramps, nausea, chronic pelvic pain, lower gastrointestinal hemorrhage, intussusception, perforation, or acute appendicitis. CONCLUSION: Appendiceal endometriosis is an unusual histopathological finding. A preoperative diagnosis is difficult, but this condition should be considered when women of childbearing age present with clinical symptoms of acute appendicitis. © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.

1. Introduction

2. Case reports

Endometriosis, defined as the presence of endometrial glands and stroma outside the uterine cavity, is estimated to affect 4–50% of reproductively aged women and results in pelvic pain and infertility in up to 50% of these patients.1–3 Endometriosis is most commonly found in the gynecologic organs and pelvic peritoneum but may also involve the gastrointestinal system, greater omentum, surgical scars, and the mesentery, but is rarely found at distant sites such as the kidney, lungs, skin, and nasal cavity.4 Gastrointestinal endometriosis (GE) is observed in 3–37% of all endometriosis cases, but appendiceal endometriosis (AE) accounts for only about 3% of GE and