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

Abstract

Background: Endometriosis is defined as functional endometrial tissue located outside of the uterine cavity. Typical symptoms include dysmenorrhea, non-cyclic dyspareunia, irregular or heavy menstrual bleeding, dyschezia, and infertility. Previously, Robotic Assisted (RA)-laparoscopic surgery was the procedure of choice when treating stage IV endometriosis. Single Incision Laparoscopic Surgery (SILS) is a new technique, gaining popularity for its versatile use in various surgical procedures. We present a case report of a patient with stage IV appendiceal endometriosis managed with Da Vinci RA-SILS appendectomy and a literature review. Case: The patient was a 34-year-old female Gravida 0, Para 0 with a chief complaint of dysmenorrhea, chronic pelvic pain and cramping. She reported a history of infertility for 18 months. The patient was diagnosed with a right pelvic sidewall nodule with endometriosis, left round ligament endometriosis, left anterior broad ligament endometriosis, posterior cul-de-sac endometriosis, with bladder, uterine, and appendiceal endometriosis. The patient underwent hysteroscopy, chromotubation, and Da Vinci RA-SILS resection of appendiceal endometriosis. Conclusion: Although rare, endometriotic involvement of appendix can be a symptomatic complication of gastrointestinal involvement and may present as acute appendicitis or even nonspecific abdominal pain, requiring appendectomy. With modern advancements, it is now preferred to perform Da Vinci RA-SILS appendectomy in the setting of endometriosis for both surgical and cosmetic reasons.