Endometriosis causing acute appendicitis complicated with hemoperitoneum

Abstract

Endometriosis is a painful disorder characterized by endometrial tissue outside the uterine cavity. It usually affects the pelvis, but in rare cases it might extend to other parts of the body. The report is based on a case of a 39-year-old woman, who presented symptoms of acute appendicitis and diagnosis confirmed with ultrasonography and a computed tomography scan procedures. Laparoscopic appendicectomy was performed. After entering the abdominal cavity, hemoperitoneum was discovered with no associated pelvic or abdominal lesions. Biopsy confirmed acute appendicitis with endometrial glands and stroma infiltrating its muscular tissue. Patient recovered without complications and was discharged 48 h after surgery. The appendix is rarely affected by endometrial infiltration. The literature describes an incidence of 0.8%, just a few cases have been associated with acute appendicitis; however, none of them are described to present hemoperitoneum, being our patient the first one reported with such complication.

Endometriosis of the appendix presenting as acute appendicitis with unusual appearance

“…However, a key component of the history was the fact that this patient was menstruating. Multiple case reports have described the involvement of menstruation in the presentation of endometriosis of the appendix [ 5 , 6 ]. This key element of the history should have prompted the surgeon to look not only for signs of acute appendicitis but also for signs of endometriosis during laparoscopy.…”

Apendiks vermiformiste divertiküler hastalık ve endometriozis: Özgün bir kombinasyon

“…5-15% of women in the reproductive period have this condition which is usually associated with dysmenorrhea, chronic pelvic pain and infertility (1,6). It is called genital endometriosis when located in the uterine muscle, cervix, vagina, ovary and fallopian tubes, and called extra genital endometriosis if located outside the genital organs in almost every organ and tissue in the body except the spleen (1,6). Endometriosis of the gastrointestinal tract involves rectosigmoid region 72%, rectovaginal septum 13%, small bowel 7%, caecum 4%, appendix 4% and other intestinal sites 0.5% (2).…”

Endometriosis causing Invaginated Mucinous Cystadenoma of Appendix: Case Report

“…Among them 80% are benign and borderline tumors and other carcinomas. The extraovarian primary form, is an unusual presentation (most of the time localized on appendix) [1,2] . Endometriosis, in the other hand, is the extrauterine presence of endometrial glands and stroma.…”

“…It normally compromises pelvic organs and less frequently other ones, like bowel, affected in 3 to 37%, whilst appendix only in 0.8% according to authors [3,4,5] . Even though the clinical presentation is chronic pelvic pain, the appendix is usually asymptomatic [2,6] . The gold standard for its diagnosis is laparoscopy, which allows direct visualization and subsequent pathologic confirmation of disease and complications [2] .…”

“…Even though the clinical presentation is chronic pelvic pain, the appendix is usually asymptomatic [2,6] . The gold standard for its diagnosis is laparoscopy, which allows direct visualization and subsequent pathologic confirmation of disease and complications [2] . This case report describes a particular presentation of invaginated mucinous cystadenoma tumor of appendix due to endometriosis successfully treated with laparoscopic surgery.…”