Acute appendicitis caused by endometriosis: a case report

We report a case of endometriosis of the appendix in a 25-year-old Caucasian woman who presented with symptoms of acute appendicitis and was treated by appendectomy, which resulted in a good outcome.We discuss special aspects of acute appendicitis caused by endometriosis to elucidate the pathologic entity of this variant of acute appendicitis.Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity and musculature [1]. It affects 4% to 50% of women of reproductive age and results in pelvic pain in up to 50% of these patients [2]. The symptomatology of the disease is often related to the location of the lesions [3], and for that reason endometriosis of the gastrointestinal tract, although rare, may cause a wide spectrum of symptoms [4-6]. Appendiceal endometriosis not only may cause symptoms of acute appendicitis [7-10] but also is known to cause cyclic and chronic right lower quadrant pain [11], melena [12], lower intestinal hemorrhage [13], cecal intussusceptions [14,15] and intestinal perforation, especially during pregnancy [16].Appendiceal endometriosis was first described in 1860 [17], while in 1951 Collins [12] reviewed a total of 150 cases in the literature. Four years afterward Collins further described more than 50,000 random pathologic assessments of the appendix and reported the prevalence of appendiceal endometriosis as 0.054% [18]. More recent studies, however, have reported the prevalence of appendiceal endometriosis to be around 0.8% [19].We describe a case of a woman with appendiceal endometriosis that presented as acute appendicitis. We additionally discuss special aspects of the disease to elucidate this variant of acute appendicitis.A 25-year-old Caucasian woman was admitted to our hospital with a two-day history of lower quadrant abdominal pain. She had no fever, but she reported nausea, vomiting and anorexia. Her McBurney's point was positive with abdominal guarding and rigidity. She had no relevant gynaecologica