Case Study: Recurrent and cyclic appendicitis in females: suspect pelvic endometriosis

Summary

Endometriosis is a well-recognized gynecological condition in the reproductive age group. Literature on appendiceal endometriosis, which is a rare condition, is inadequate. The presentation to general surgeons may be atypical and pose diagnostic difficulty. Thus, a thorough history, gynecological assessment, radiology and serology may be very useful, and a definitive diagnosis is likely to be established only by the histological examination of the appendicectomy specimen. Here we shall discuss the case of a 32-year-old female.

Background

Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity and musculature. It has been found in about 4% of women during tubal ligation, but also in up to 50% of teens who have intractable dysmenorrhea , and it results in pelvic pain in up to 50% of these patients . According to the Journal of Medical Case Reports, “Recent studies reported the prevalence of appendiceal endometriosis to be around 0.8%. Appendiceal endometriosis not only may cause symptoms of acute appendicitis but also is known to cause cyclic and chronic right lower quadrant pain, melena, lower intestinal hemorrhage, cecal intussusceptions and intestinal perforation, especially during pregnancy .” Here I shall describe a case of a woman with appendiceal endometriosis that presented as recurrent and periodical appendicitis. The pathology was detected incidentally during routine histopathology, and accordingly, hormone therapy was given.

Case Presentation

A 32-year-old female P1+0, presented with recurrent right iliac fossa pain for the last 8 months. Her previous childbirth was a normal vaginal delivery and was uneventful. The pain was related to her painful periods and was cyclical. No lump but tenderness was elicited at the McBurney’s point. There was no fever, but nausea and loss of appetite were present. No organomegaly was found.

Investigations

1. Urine and stool chemical and microscopic examination: normal
2. Urine microbiology: no growth
3. USG lower abdomen: enlarged uterus, small cysts in both ovaries
4. Blood routine tests: neutrophilic leucocytosis
5. Serology CA-125: elevated (done post-operatively), WIDAL: not contributory
6. Urine pregnancy test: negative

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