A rare case of right lower quadrant pain

Abstract

Endometriosis of the appendix is a very rare entity and commonly affects females in childbearing age. Clinical presentation might be confusing varying from asymptomatic to acute abdominal pain and often mimicks acute appendicitis or chronic pelvic pain. Diagnosis is generally made after pathological examination as operative findings are usually non-specific. This condition poses a diagnostic challenge to radiologists and surgeons altogether and we therefore report a case of a middle aged female who presented with both right lower quadrant and right lower back pain. Recent literature is reviewed and radiological findings discussed.

Acute Appendicitis Secondary to Appendiceal Endometriosis

“…Most cases of deep intestinal endometriosis invade the rectum and sigmoid colon and are usually multifocal [ 5 ]. However, appendiceal endometriosis is a rare phenomenon, with a reported incidence in the literature ranging from 0.05% to 1.69% [ 6 – 11 ] of patients with endometriosis. Among patients who are surgically treated for deep endometriosis, appendiceal involvement is observed in 2.6% to 13.2% of cases [ 12 , 13 ].…”

“…In symptomatic cases, this condition can simulate acute appendicitis [ 6 , 7 , 14 ]. Preoperative diagnosis based on physical examination and imaging tests can be challenging.…”

“…The clinical picture may be characterized by lower abdominal pain and lower back pain on the right [ 6 , 8 , 15 ]; pain in the right iliac fossa [ 7 ]; or, even more characteristic of acute appendicitis, periumbilical pain migrating to the right iliac fossa [ 14 , 16 ]. Associated symptoms such as anorexia, nausea, and vomiting are frequently present [ 8 , 14 – 16 ].…”

“…Associated symptoms such as anorexia, nausea, and vomiting are frequently present [ 8 , 14 – 16 ]. Signs of peritonitis [ 6 – 8 ] and changes in vital signs, such as fever and tachycardia, were not found [ 7 , 8 , 14 ], except in one report of painful abrupt positive decompression located at McBurney's point [ 16 ].…”

“…Computed tomography may not show changes [ 14 ]; it may show only thickening of the appendiceal wall [ 8 ], with or without a surrounding hypodense masses [ 5 ]; or it may show a mass inside the appendix [ 6 ], parietal thickening, and an intraluminal mass with periappendiceal infiltrate [ 15 ] or even focal nodules in the appendix body [ 5 ].…”