Concurrent appendiceal and umbilical endometriosis: a case report and review of the literature

Abstract

IntroductionEndometriosis affects 3 to 10 percent of women of reproductive age. Most of the time it involves the pelvis; however, sites of endometriosis have been reported almost anywhere in the body. Appendiceal and primary umbilical endometriosis are considered rare loci, making accurate diagnosis elusive. Here we present the case of a 46-year-old woman with concurrent appendiceal and umbilical endometriosis.Case presentationA 46-year-old Greek woman presented with a large mass in the lower abdomen adhering to the surrounding organs. She reported recurrent lower abdominal and pelvic pain and the presence of a dark-blue hard nodule at the umbilicus. She had no previous medical, surgical or gynecological history. Her physical examination and laboratory test results were without any significant findings. The laparotomy revealed a fibromatose uterus adhering to the rectum and a urinary cyst and a palpable mass in the vermiform appendix. A hysterectomy and an appendectomy were performed. The umbilical mass was also excised. Pathology revealed endometriosis of the umbilicus and the appendix. The postoperative period was uneventful and she was discharged.ConclusionsEndometriosis, although rare, should always be considered in women of reproductive age, presenting with cyclic pain. The diagnosis is, most of the time, difficult and requires a high degree of clinical suspicion. The clinical doctor should be aware that endometriosis can sometimes be multifocal, thus a thorough investigation is required in all cases.

Iatrogenic Endometriosis after Laparoscopic Hysterectomy with Vaginal Power Morcellation: A Case Report

“…This is unlikely because the patient had a preoperatory physical examination and a transvaginal and transabdominal ultrasound without endometriosis findings. In addition, the intraoperative examination was normal; [2] the spread of endometrial tissue in the pelvis during the power morcellation procedure that remained in the abdominal cavity after surgery. This one could be the most logical explanation, although very rare and infrequent tough.…”

“…Both endometriosis and uterine fibroids are gynecologic disorders that affect many women of reproductive age. They are a prevalent indication for surgical intervention and share symptoms like menorrhagia, dysmenorrhea, pelvic pain and subfertility [2] and other common features such as sex hormone sensitivity [3,4].…”

“…While myomas are accurately diagnosed via pelvic imaging such as ultrasound (US) or magnetic resonance imaging (MRI), the gold standard for endometriosis diagnosis is surgical visualization or biopsy [2]. However, there are useful imaging techniques like enhanced MRI and endoanal US for patients with suspected rectovaginal endometriosis which give an accurate picture of the whole pelvic disease [3].…”

Da vinci SILS-appendectomy for appendiceal endometriosis secondary to stage IV endometriosis: a case report and review of literature

“…3 Although endometriotic involvement of the appendix is rare (0.8%), it can present with variety of symptoms, or be asymptomatic. 2,6 Even rarer are severe symptoms of underlying appendiceal endometriosis presenting as acute appendicitis or acute abdomen. [7][8][9] Laparoscopic appendectomy is the gold standard treatment for endometrial appendiceal because it allows for thorough surgical exploration of the abdomen, especially in patients with recurrent or unexplained pelvic pain.…”

“…[7][8][9] Laparoscopic appendectomy is the gold standard treatment for endometrial appendiceal because it allows for thorough surgical exploration of the abdomen, especially in patients with recurrent or unexplained pelvic pain. 2,6,10 Current applications for the procedure include, but are not limited to: tubal ligation, hysterectomy, appendectomy, cholecystectomy, gastrectomy, colectomy, and nephrectomy. 11 The procedure is gaining traction because of reduced post-operative pain or complications, and cosmetic advantages.…”