Endometriosis of the Appendix: When to Predict and How to Manage—A Multivariate Analysis of 1935 Endometriosis Cases

Mabrouk, Mohamed; Raimondo, Diego; Mastronardi, Manuela; Raimondo, Ivano; Forno, Simona Del; Arena, Alessandro; Sutherland, Neveta; Borgia, A.; Mattioli, Giulia; Terzano, Patrizia; Seracchioli, Renato

doi:10.1016/j.jmig.2019.02.015

Cited by 30 publications

(32 citation statements)

References 35 publications

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“…Surprisingly, the principal recent surgical series, using either conservative (shaving) or radical resection techniques, have reported rates of ICE in LRE patients ranging from 0 to 10.2%, much lower than the 25.6% rate we report here. Similarly, the reported rates of isolated appendiceal endometriosis in women with DIE have ranged from 2.6 to 4.1%, again lower than our 7.5% rate . It may be hypothesised that the ICE lesions might have been missed and left in place.…”

Section: Discussioncontrasting

confidence: 69%

“…This may explain in part why ICE might be considered clinically silent, and it reinforces the importance of specific and appropriate questioning when endometriosis is suspected. The rationale for this additional resection of silent ICE lesions might thus be questioned, and data on surgical complications and clinical outcomes related to appendectomy for occult appendiceal endometriosis are lacking . However, in previous reports, combined resection of ileocaecal lesions with LRE neither increased postoperative morbidity nor impaired functional results .…”

Section: Discussionmentioning

confidence: 99%

“…In women who have undergone surgery for bowel endometriosis, the reported prevalence of ileocaecal endometriosis (ICE) ranges from 5 to 10.2% . Most surgical teams have standardised a complete preoperative imaging work‐up to obtain a detailed map of endometriotic disease before surgery; however, available data show that this process often misses diagnoses of additional ICE lesions …”

Section: Introductionmentioning

confidence: 99%

“…Lesions are more frequently observed in the posterior compartment and on the left side in the pelvis, whereas the opposite is true in the abdomen. Accordingly, we supposed that ICE in women with LRE may result from broader anatomical extension of the lesions, as isolated cases of ICE are rare . We therefore studied women with histologically proven LRE in a large cohort from a referral centre by distinguishing women with and without ICE to determine its prevalence and to compare outcomes in these two groups.…”

Section: Introductionmentioning

confidence: 99%

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Associated ileocaecal location is a marker for greater severity of low rectal endometriosis

Marcellin

Leconte

Gaujoux

et al. 2019

BJOG

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Objective To determine whether ileocaecal endometriosis (ICE) is a marker for low rectal endometriosis (LRE) severity.Design Retrospective cohort study. Setting France.Population and sample Analysis of 375 colorectal resections performed in women undergoing complete surgery for LRE from January 1995 to December 2015 in a university centre for endometriosis.Methods Univariate and multivariate analysis of anatomical, postoperative clinical, and long-term outcomes according to presence of ICE.Main outcomes and measures Mean number and type of deep infiltrating endometriosis (DIE) lesions, the existence of an associated endometrioma, and mean total American Society for Reproductive Medicine (ASRM) score.Results The prevalence of ICE was 25.6%. Primary end-point data showed that women with ICE had a significantly higher adjusted number of DIE lesions (OR = 1.43, 95% CI 1.02-3.03; P = 0.048), higher prevalence of endometriomas (OR = 1.91, 95% CI 1.04-3.51; P = 0.044), more associated DIE sigmoid lesions (OR = 2.12, 95% CI 1.07-3.91; P = 0.025), and a higher mean total ASRM score (OR = 2.07, 95% CI 1.12-4.14; P = 0.025). Women with ICE resected during the surgical procedure for LRE did not have more adverse postoperative clinical outcomes than ICE-negative patients.Conclusion Ileocaecal endometriosis was significantly associated with greater LRE severity. In a complete surgical resection strategy, combining resection of ICE and LRE did not appear to increase postoperative rates of complications, morbidity or recurrence, nor did it seem to impair long-term clinical outcomes.Keywords Complete surgery, deep infiltrating endometriosis, disease severity, ileocaecal endometriosis, low rectal endometriosis.Tweetable abstract In women with low rectal endometriosis, 25% have an associated ileocaecal location that is a marker for severity.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Associated ileocaecal location is a marker for greater severity of low rectal endometriosis

Marcellin

Leconte

Gaujoux

et al. 2019

BJOG

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“…In our study, there are 4 patients with appendiceal endometriosis are responsible for approximately 4% of all intestinal lesions. Diego Raimondo et al [27] pointed out that appendiceal endometriosis was associated with adenomyosis, large right endometrioma, deep posterior pelvic endometriosis, left deep lateral pelvic endometriosis, and ileocecal involvement. The 4 patients in our study who had appendiceal endometriosis were all combined with adenomyosis, and the diameter of OEM was greater than 5cm, which was further validated the conclusions of Diego Raimondo et al…”

Section: Discussionmentioning

confidence: 99%

Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: An observational clinical study

Kwok

Jiang

et al. 2020

Preprint

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Background: To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods: The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and >50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results: DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n=184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n=120 patients; 2.76±1.52 vs. 2.33±1.34; P=0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P<0.01) and vaginal (17.4% vs. 6.7%; P<0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83±1.56 vs. 2.74±1.53; P=0.678; and 2.65±1.42 vs. 2.80±1.43; P=0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and >50 mm. Conclusion: Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe. Key Words: ovarian endometrioma, deep infiltrating endometriosis, lesion distribution characteristics

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Occult appendix pathology in patients undergoing colorectal cancer resection and prophylactic appendectomy

Di Fabio,

Ravi,

Allievi

et al. 2023

World j. surg.

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BackgroundThe risk‐benefit balance of prophylactic appendectomy in patients undergoing left colorectal cancer resection is unclear. The aim of this report is to assess the proportion of histologically abnormal appendices in patients undergoing colorectal cancer resection in a unit where standard of care is appendectomy, with consent, when left‐sided resection is performed.MethodsA retrospective study on a prospectively collected database was conducted in a single tertiary‐care center. Overall, 717 consecutive patients undergoing colorectal cancer resection between January 2015 and June 2021 were analyzed. The primary outcome was the proportion of histologically abnormal appendix specimens at prophylactic appendectomy. The secondary outcome was complications from prophylactic appendectomy.ResultsOverall, 576/717 (80%) patients had appendectomy at colorectal cancer surgery. In total, 234/576 (41%) had a right‐/extended‐right hemicolectomy or subtotal colectomy which incorporates appendectomy, and 342/576 (59%) had left‐sided resection (left‐hemicolectomy, anterior resection or abdominoperineal excision) with prophylactic appendectomy. At definitive histology, 534/576 (92.7%) had a normal appendix. The remaining 42/576 (7.3%) showed abnormal findings, including: 14/576 (2.4%) inflammatory appendix pathology, 2/576 (0.3%) endometriosis, 8/576 (1.4%) hyperplastic polyp, and 18/576 (3.1%) appendix tumors, which encompassed six low‐grade appendiceal mucinous neoplasms (LAMNs), three carcinoids, and nine serrated polyps. In the 342 patients who had prophylactic appendectomy, 10 (2.9%) had a neoplasm (two LAMN, three carcinoids, and five serrated polyps). There were no complications attributable to appendectomy.ConclusionOccult appendix pathology in patients undergoing colorectal cancer resection is uncommon when prophylactic appendectomy was performed. However, approximately 3% of patients had a synchronous appendix neoplasm.

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Endometriosis of the Appendix: When to Predict and How to Manage—A Multivariate Analysis of 1935 Endometriosis Cases

Cited by 30 publications

References 35 publications

Associated ileocaecal location is a marker for greater severity of low rectal endometriosis

Associated ileocaecal location is a marker for greater severity of low rectal endometriosis

Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: An observational clinical study

Occult appendix pathology in patients undergoing colorectal cancer resection and prophylactic appendectomy

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