Appendiceal Endometriosis: A Comprehensive Review of the Literature

Abstract

Objective: the purpose of this review was to evaluate the prevalence of appendiceal endometriosis and the safety of concomitant appendectomy in women with endometriosis or pelvic pain. Materials and Methods: We searched the electronic databases Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was not subject to any limitation in terms of time or method. The primary research question was: what is the prevalence of appendiceal endometriosis? The secondary research question was: is it safe to perform appendectomy during surgery for endometriosis? Publications that reported data about appendiceal endometriosis or appendectomy in women with endometriosis were reviewed regarding the inclusion criteria. Results: We found 1418 records. After review and screening, we included 75 studies published between 1975 and 2021. With regard to the first question of the review, we found 65 eligible studies and divided these into the following two categories: (a) endometriosis of the appendix presenting as acute appendicitis, and (b) endometriosis of the appendix as an incidental finding in gynecological surgery. Forty-four case reports described appendiceal endometriosis in women who were admitted for the treatment of pain in the right-sided lower abdomen. Endometriosis of the appendix was observed in 2.67% (range, 0.36–23%) of women who were admitted due to acute appendicitis. In addition, appendiceal endometriosis was an incidental finding during gynecological surgery in 7.23% of cases (range, 1–44.3%). With regard to the second question of the review, which was the safety of appendectomy in women with endometriosis or pelvic pain, we found 11 eligible studies. Reviewed cases had no significant intraoperative or follow-up complications during the 12 weeks. Conclusion: Based on the reviewed studies, coincidental appendectomy appears reasonably safe and was associated with no complications in the cases reviewed for the present report.

The expanding role of sonography for the diagnosis of deep infiltrating endometriosis: Results of a large case series

“…The incidence of appendiceal endometriotic implantation was noteworthy, suggesting that when considering the diagnosis of endometriosis, the appendix should be routinely examined at surgical exploration. Appendiceal endometriosis has been previously mentioned when the diagnosis of endometriosis is discussed, and this case series confirms it as a recognized category of endometriosis 18 …”

The Vermiform Appendix and Its Pathologies

“…Another rare condition of the vermiform appendix is endometriosis [165]. Appendiceal endometriosis may be asymptomatic or may cause similar manifestations of acute and chronic appendicitis, being also associated with cyclic and chronic right lower quadrant pain, melena, lower intestinal hemorrhage, cecal intussusception, and intestinal perforation [173,174].…”

Endometriosis of the Appendix: A Narrative Review

“…The benefits of performing an appendectomy for patients with endometriosis of the appendix is that it improves the symptoms of chronic abdominal pain and eliminates the risk of future appendicitis. There is a role for performing an incidental appendectomy during gynecological surgery for endometriosis as it is associated with reduced morbidity and mortality [9][10][11][12][13].…”