Risk of appendiceal endometriosis among women with deep‐infiltrating endometriosis

Moulder, Janelle K.; Siedhoff, Matthew T.; Melvin, Kathryn; Jarvis, Elizabeth G.; Hobbs, K.A.; Garrett, Joanne M.

doi:10.1002/ijgo.12286

Cited by 27 publications

(51 citation statements)

References 26 publications

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“…Among all these patients, the presence of appendiceal neoplasia was detected in one patient, leading to a frequency of appendiceal neoplasia of 1 in 12 (8.3%) among all our appendectomies and 1 in 124 (0.8%) of all surgeries for DIE with intestinal resection. The incidence of appendectomies in our series is comparable with that in other series [4,12], which reinforces the importance of a complete evaluation of the peritoneal cavity during laparoscopy in patients with DIE. In addition, it is essential to map the endometriosis lesions during the preoperative evaluation to facilitate surgical planning and ensure a complete evaluation of the intestine during laparoscopy.…”

Section: Discussionsupporting

confidence: 88%

“…Surgery is indicated in patients with pelvic pain who do not respond to medical therapy and/or in patients with ileal involvement, owing to the risk of intestinal obstruction, and in those with appendiceal involvement, owing to the higher risk of neoplasia in these cases [2,4]. Previous studies have suggested that appendiceal endometriosis is not a rare entity and occurs in up to 2.8% of patients with endometriosis [5] and up to 13.2% of patients with DIE [4]. The percentage is higher in patients with more severe disease or in those with lesions at multiple sites [4].…”

Section: Introductionmentioning

confidence: 99%

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Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report

et al. 2020

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Introduction Endometriosis of the appendix is very uncommon, accounting for only about 1% of all cases of endometriosis. However, endometriosis is found in the appendix in approximately 8–13% of patients with deep infiltrating endometriosis and is particularly common in patients with severe forms of deep infiltrating endometriosis. Neuroendocrine tumors are the most common neoplasms of the appendix and may be misdiagnosed when there are multiple endometriosis lesions in the pelvis. Case presentation We describe a case of a Caucasian patient with deep infiltrating endometriosis with rectal involvement, retrocervical lesions, and a right ovarian endometrioma with no suspected lesions in the appendix. She underwent laparoscopy and, after a systematic intraoperative evaluation, suspected involvement of the appendix was observed. The patient underwent ovarian cystectomy, excision of the pelvic endometriosis lesions, appendectomy, and anterior stapler discoid resection. Histopathological analysis of the appendix revealed endometriosis and a well-differentiated neuroendocrine carcinoma at the appendix tip. Discussion Our patient’s case emphasizes the need to approach these lesions carefully and strengthens the indication for appendectomy when the appendix is affected in the setting of endometriosis. Despite the more likely diagnosis of appendiceal endometriosis, neuroendocrine tumors cannot be ruled out by imaging examinations, and both conditions can occur in the same patient.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report

et al. 2020

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“…Out of the patients evaluated, nearly 50% have deep involvement by endometriosis, while 32% showed appendiceal involvement. 16 Although these patients were asymptomatic, the level of infiltration was indicative for surgical intervention. 16 It has been suggested that prophylactic concurrent appendectomy be performed as part of complete endometriosis excision.…”

Section: Discussionmentioning

confidence: 93%

“…16 Although these patients were asymptomatic, the level of infiltration was indicative for surgical intervention. 16 It has been suggested that prophylactic concurrent appendectomy be performed as part of complete endometriosis excision. 16 Unusually, other intra-abdominal pathology can be mimicked by pain from appendiceal endometriosis.…”

Section: Discussionmentioning

confidence: 93%

“…16 It has been suggested that prophylactic concurrent appendectomy be performed as part of complete endometriosis excision. 16 Unusually, other intra-abdominal pathology can be mimicked by pain from appendiceal endometriosis. 17 Isolated, deeply located appendiceal involvement may be missed by diagnostic laparoscopy; and can present with no external diagnostic features, therefore routine appendectomy has also been advocated in women with recurrent abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

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

Guan¹,

Rezai²,

Patel³

et al. 2018

OGIJ

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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.

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Appendectomy in the surgical management of women with endometriosis and pelvic pain

Ross

Chu

et al. 2021

Intl J Gynecology & Obste

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Objective To evaluate the role of appendectomy in surgical excision of endometriosis and to assess complications associated with appendectomy. Methods Retrospective study of women undergoing appendectomy for pelvic pain and/or endometriosis during a primary gynecologic procedure. Results Record review was performed for 609 women who underwent appendectomy between 2013 and 2019 for pelvic pain (6.9%, 42/609), stage I–II endometriosis (63.7%, 388/609), or stage III–IV endometriosis (29.4%, 179/609). Appendiceal endometriosis (AppE) was present in 14.9% (91/609); 2.4% without endometriosis (1/42, reference group), 7.0% with stage I–II endometriosis (27/388, odds ratio [OR] 3.06, 95% confidence interval [CI] 0.41–23.11, P = 0.278), and 35.2% with stage III–IV endometriosis (63/179, OR 22.24, 95% CI 2.99–165.40, P = 0.002). AppE was significantly associated with endometriosis present in other locations (OR 5.27, 95% CI 2.66–10.43, P < 0.001). The predicted probability of identifying AppE ranged from 6% with 0 positive endometriosis sites to 56% when 4 or more sites were identified. There were no complications related to the performance of an appendectomy. Conclusion Women with chronic pelvic pain and/or endometriosis have an increased risk of AppE. Modern appendectomy at the time of gynecologic surgery is safe, with no associated complications in this study. Our findings support the consideration of appendectomy as part of the comprehensive surgical management of endometriosis.

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Risk of appendiceal endometriosis among women with deep‐infiltrating endometriosis

Abstract: Women with DE have increased risk of AppE. Coincidental appendectomy should form part of complete endometriosis excision for these patients.

Cited by 27 publications

References 26 publications

Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report

Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report

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

Appendectomy in the surgical management of women with endometriosis and pelvic pain

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