Diagnostic Challenge of Appendiceal Endometriosis: A Case Report

Endometriosis is a chronic, estrogen-dependent disease affecting women of reproductive age. Although extragenital involvement is not uncommon, appendiceal endometriosis is a rare entity that may present with acute abdominal pain, often mimicking acute appendicitis and posing a diagnostic challenge. We report the case of a 28-year-old woman who presented with right lower quadrant abdominal pain and clinical suspicion of acute appendicitis. She underwent a laparoscopic appendectomy. Histopathological examination of the specimen revealed endometriosis of the appendix. The postoperative course was uneventful. This case highlights the diagnostic overlap between appendiceal endometriosis and acute appendicitis, in line with previous reports. Consistent with earlier findings, appendiceal involvement may occur independently or in association with other pelvic sites. The absence of luminal inflammation, as observed here, differentiates this case from those with concurrent inflammatory appendicitis. Routine histopathologic assessment remains crucial, as many lesions are microscopic and clinically silent. Laparoscopy plays a pivotal role by allowing direct visualization, safe resection, and evaluation for additional endometriotic implants. Appendiceal endometriosis should be considered in women presenting with acute or recurrent right lower quadrant pain. Laparoscopy combined with systematic histological examination provides definitive diagnosis and optimal management, helping prevent misdiagnosis of this rare but clinically significant entity.