Appendicular endometriosis

Specialty: Gynecology and breast.

• Endometriotic implant in the appendix
• catamenial appendicitis
• cyclic appendiceal pain

Why it occurs

• Presence of ectopic foci of endometrial tissue in the serosa, muscle or mucosa of the cecal appendix, which suffer inflammation, peeling and repeated microbleeds during menstruation, simulating or triggering a condition of acute appendicitis coinciding with the cycle

Initial workup

High-resolution abdominal ultrasound or Computed Tomography (CT) of the abdomen and pelvis with contrast (the cecal appendix dilated >6 mm is visualized, with thickened walls, loss of definition of surrounding fatty planes and heterogeneous nodular implants in its vicinity). Complete blood count with leukocyte count and CRP to assess the degree of systemic inflammatory response.

Standard management

• There is no exclusive medical treatment available for acute appendicitis established secondary to endometriosis. Acute pain is managed with intravenous analgesics in the hospital after surgical evaluation. The definitive treatment of the established picture of acute appendicitis due to endometriosis is laparoscopic appendectomy. If the pain is dull, recurrent in a cyclical manner and an acute obstructive inflammatory process has been ruled out by imaging tests, hormonal suppressive treatment with continuous combined contraceptives or Dienogest 2 mg orally per day on a prolonged basis can be prescribed to induce atrophy of the appendicular ectopic endometrial tissue (note: the appendectomy performed during deep endometriosis resection surgery prevents the recurrence of pain in the iliac fossa right).