Acute appendicitis secondary to endometriosis of the appendix: A case series (2019)

Type of publication:
Conference abstract

Argyriou O.; Wall M.; Johnson M.; Sutton P.A.; *Tamvakeras P.

Colorectal Disease; 2019; vol. 21, S2, p. 36-37

Purpose: To review the clinical presentation, laboratory results, imaging and operative findings of patients subsequently found to have histological evidence of endometriosis of the appendix in a District General Hospital (DGH) between 2016-2018. Method(s): Ten histological reports containing the search term "endometriosis of the appendix" were identified. Four were excluded as planned gynaecological resections for known endometriosis. The case notes, laboratory and imaging reports of six patients were reviewed. Result(s): In three patients, a 72-h or less history of right iliac fossa (RIF) pain was present (24-h or less in two), whereas on two occasions there was a 3-week history of intermittent RIF pain. Three patients reported nausea and vomiting and two were pyrexial. No history of diarrhoea was reported. Inflammatory markers (white cell count-WCC, C-reactive protein-CRP) were raised on three occasions. In five patients, available imaging (CT/USS) was suggestive of an inflammatory process in the right iliac fossa, with principle diagnosis being acute appendicitis, and in one the diagnosis was solely clinical. In all six cases, acute appendicitis was found intraoperatively. The Alvarado score ranged from 4-7. Conclusion(s): Endometriosis of the appendix may present to surgical teams as acute appendicitis. Surgeons should be aware that a longer history of intermittent RIF pain and normal inflammatory markers does not exclude appendicitis secondary to endometriosis. An appendicectomy should be performed, as the aetiology does not appear to otherwise affect the natural history of this condition.

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