Appendiceal disease in women with endometriosis and right lower quadrant pain
R S Harris1, W G Foster, M W Surrey
1Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 160W, Los Angeles, CA 90048, USA.
Study Objective:
To evaluate the frequency and range of appendiceal disease in women with endometriosis and right lower quadrant (RLQ) pain, and to estimate the value of preoperative gastrograffin enema (GGE) as a screen for the disease.
Design:
Nonrandomized clinical trial (Canadian Task Force classification II-2).
Setting:
University-affiliated hospital with a private practice setting.
Patients:
A subpopulation of 65 women from a group of 337 patients undergoing laparoscopy for symptomatic endometriosis.
Intervention:
Preoperative GGE was performed whenever possible in these women. At laparoscopy, the appendix was removed if it appeared abnormal or if the preoperative GGE was positive.
Measurements And Main Results:
Of 65 women (19%) with symptomatic endometriosis and preoperative RLQ pain, 52 (80%) underwent appendectomy as part of surgery. Of these 52 excised appendixes, 39 (75%) had histologically confirmed pathology including appendicitis or periappendicitis, endometriosis, fibrous obliteration, lymphoid hyperplasia, and carcinoid tumor. Preoperative GGE had sensitivity of 74% and specificity of 83% for appendiceal disease. Its positive predictive value was 95% and negative predictive value was 42%. No complications from laparoscopic appendectomy occurred.
Conclusion:
Disease of the appendix is common in women with endometriosis and RLQ pain. Appendectomy is particularly likely if preoperative GGE is positive.
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