Small Bowel Obstruction Secondary to Endometriosis Affecting the Appendix in a Patient With a Virgin Abdomen

A 62-year-old otherwise healthy Caucasian female patient presented to the emergency department with a one-day history of severe abdominal pain, accompanied by nausea and non-bloody emesis. She did not report any prior similar episodes and denied any history of abdominal surgery. Although she did not report a history of diagnosed endometriosis, she did report a history of dysmenorrhea. Laboratory tests in the emergency room showed mild leukocytosis. A computed tomography (CT) scan of the abdomen showed a small bowel obstruction with a transition point in the right lower quadrant with associated reactive enteritis. A diagnostic laparoscopy was subsequently performed. Intraoperatively, we found an adhesive band from the appendix to the sigmoid colon resulting in an internal hernia. Laparoscopic adhesiolysis was performed to release the adhesive band, and since the appendix looked a little abnormal, the decision was made to perform an appendectomy. Her surgical pathology showed endometriosis near the appendiceal tip, estrogen receptor-positive (ER+). Her peritoneal fluid cytology was negative for malignant cells. The patient did well post-operatively and had no complications.