Endometriosis causing acute appendicitis complicated with hemoperitoneum.

Area of Science:

• Gynecology
• Gastroenterology
• Pathology

Background:

• Endometriosis is a condition where endometrial tissue grows outside the uterus, typically causing pelvic pain.
• While rare, endometriosis can affect other body parts, including the appendix.
• Appendiceal endometriosis is uncommon, with a reported incidence of 0.8%.

Observation:

• A 39-year-old woman presented with symptoms mimicking acute appendicitis.
• Diagnostic imaging, including ultrasonography and CT scans, confirmed appendicitis.
• During laparoscopic appendectomy, hemoperitoneum was noted without other discernible abdominal or pelvic lesions.

Findings:

• Histopathological examination of the appendix revealed acute appendicitis with endometrial glands and stroma infiltrating the muscularis propria.
• This infiltration led to the observed hemoperitoneum, a complication not previously documented in appendiceal endometriosis cases.
• The patient recovered fully and was discharged within 48 hours post-surgery.

Implications:

• This case highlights the potential for appendiceal endometriosis to present with acute abdominal symptoms and hemoperitoneum.
• It underscores the importance of considering endometriosis in the differential diagnosis of acute appendicitis, especially in women of reproductive age.
• This report represents the first documented instance of hemoperitoneum associated with endometriosis of the appendix, expanding the known clinical spectrum of the disease.