Endometriosis of the appendix is an uncommon finding which can present similar to acute appendicitis.
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A key feature of the history will be ongoing menstruation in a reproductive aged female.
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We recommend removal of the appendix should be based on history and symptoms rather than appearance during laparoscopy.
Abstract
Introduction
Endometriosis of the appendix is an uncommon mimicker of acute appendicitis which makes for a diagnostic dilemma.
Presentation of case
We present a rare case of a menstruating woman presenting with classic symptoms of appendicitis, without the characteristic inflammatory changes seen on laparoscopy consistent with appendicitis. Instead, the appendix appeared unusually contracted on itself. Pathologic review of the appendix revealed microscopic findings of endometriosis.
Discussion
We theorize the growth and shedding of the endometrial tissue during menstruation caused compression of the neural plexi in the wall of the appendix leading to the presentation mimicking acute appendicitis.
Conclusion
Given the potential for endometrial appendicitis, we propose appendectomy in reproductive age female patients with right lower quadrant pain, regardless of appendix appearance on laparoscopy.
