{"paper_id":"3d84ab52-a4b0-4443-a22d-3e1f45705b59","body_text":"WOMEN'S IMAGING\nI J Radiol. 2025 April; 22(2): e142342 https://doi.org/10.5812/iranjradiol-142342\nPublished Online: 2025 April 30 System atic Review\nCopyright © 2025, Shakki Katouli et al. This open-access article is available under the Creative Commons Attribution 4.0 (CC BY 4.0) International License\n(https://creativecommons.org/licenses/by/4.0/), which allows for unrestricted use, distribution, and reproduction in any medium, provided that the original\nwork is properly cited.\nHow to Cite: Shakki Katouli F, Torabi S, Akhavan Malayeri A, Rahnamay Farnood P, Qhorani H, et al. Imaging Findings in Symptomatic Appendiceal\nEndometriosis: A Systematic Review of Case Reports. I J Radiol. 2025; 22 (2): e142342. https://doi.org/10.5812/iranjradiol-142342.\nImaging Findings in Symptomatic Appendiceal Endometriosis: A\nSystematic Review of Case Reports\nFatemeh Shakki Katouli 1 , 2 , Sarah Torabi \n 2 , 3 , Ava Akhavan Malayeri \n 4 , Parnia Rahnamay Farnood\n2 , Hamed Qhorani 2 , 5 , Fahimeh Azizinik \n 2 , 6 , Leila Bayani 1 , Jayran Zebardast \n 2 , 7 , * , Reyhane\nYahya \n 2\n1 Department of Radiology, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran\n2 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Sciences,\nTehran, Iran\n3 Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran\n4 Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran\n5 School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran\n6 Department of Radiology, Amir Alam Hospital and Yas Women Hospital Complex, Tehran University of Medical Scienced, Tehran, Iran\n7 Department of Cognitive Linguistics, Institute for Cognitive Science Studies (ICSS), Tehran, Iran\n*Corresponding Author: Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Tehran University of Medical Science,Tehran, Iran. Email: jayran.zebardast@gmail.com\nReceived:6July, 2023;Revised:26April, 2025;Accepted:26April, 2025\nAbstract\nContext: Imaging is crucial in evaluating women with suspected appendiceal endometriosis (AE), as the condition often mimics acute or chronic appendicitis\nand presents a diagnostic challenge. While modalities like ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) can help\nidentify abnormalities, their findings are frequently nonspecific. Therefore, awareness of imaging features is essential for accurate diagnosis and management,\nthough definitive confirmation still relies on histopathological examination after surgical excision.\nO bjectives: The present study aimed to review and investigate imaging findings in symptomatic AE.\nMethods: This systematic review was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.\nPubMed, Scopus, Web of Science, CINAHL Plus, and the Cochrane Library were searched using keywords including appendix, endometriosis, MRI, transvaginal\nsonography (TVS), and transrectal high intensity focused US. Studies were included if they reported imaging findings in symptomatic AE. Exclusion criteria were\nrandomized controlled trials, controlled case studies, review articles, cohort studies, systematic reviews, conference abstracts, articles without full text, and non-\nEnglish language articles. Study selection and data extraction were performed independently by two reviewers. The quality of included case reports was\nindependently assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for case reports.\nResults: Twenty-six out of the total number of patients who underwent CT (30) had positive findings (86.6%), while 7 out of the total number of patients who\nunderwent MRI (11) and 11 out of the total number of patients who underwent sonography (13) also had positive findings (63.6% and 84.6%, respectively). The\nmean age of the patients was 37.2 ± 7.07 years. Out of the total sample, 8 patients were pregnant. The overall imaging findings were: Normal (6 cases, 15%), wall\nthickening (9 cases, 22.5%), mass (15 cases, 37.5%), cystic mass (1 case, 2.5%), solid lesion in the left ovary (1 case, 2.5%), mucocele (3 cases, 7.5%), intussusception (4\ncases, 10%), obstruction (5 cases, 12.5%), suspected obstruction (1 case, 2.5%), appendicitis (4 cases, 10%), fluid (11 cases, 27.5%), and abscess (3 cases, 7.5%).\nConclusion: Right lower quadrant (RLQ) mass and bowel wall thickening are the most commonly reported findings in patients with AE. Further studies are\nrequired to retrospectively evaluate the imaging findings of the appendix in pathologically confirmed AE after pelvic surgery.\nKeywords:Appendiceal Endometriosis,Bowel Endometriosis,Deep Endometriosis,Transvaginal Sonography,Computed\nTomography,Magnetic Resonance Imaging,MR Enterography\n1. Context\nEndometriosis is a chronic inflammatory condition\ncharacterized by the growth of endometrium-like\nepithelium and/or stroma outside the uterus. It affects\napproximately 2 - 10% of women in the general\npopulation and could be seen in up to 50% of women\nwith fertility problems (1). The most common symptoms\nof endometriosis include dysmenorrhea, dyspareunia,\nmenorrhagia, and infertility (2). Deep infiltrating\nendometriosis (DIE) is endometrium-like tissue lesions\nin the abdomen, extending on or under the peritoneal\n\nShakki Katouli F et al. Brieflands\n2 I J Radiol. 2025; 22(2): e142342\nsurface, usually in nodular form, with the ability to\ninvade adjacent structures, and in association with\nfibrosis and disruption of normal anatomy (3). This is\nthe most severe type of endometriosis, which can\ninvolve the intestines and urinary tract, leading to\nsevere symptoms in patients.\nAppendiceal endometriosis (AE) is a rare site of DIE.\nIn the literature, AE prevalence is highly variable (from\n0.2% to 39%) based on the study population. Among\npatients undergoing appendectomy for suspected acute\nappendicitis, the prevalence of AE has been reported as\n2.67%. The type and severity of endometriosis may\ninfluence AE prevalence; rates of 11.6% in women with\nsuperficial endometriosis and 39.0% in those with DIE\nhave been reported (4, 5). The symptoms of AE can\nmimic those of acute or chronic appendicitis.\nPreoperative imaging diagnosis is challenging, and AE is\noften diagnosed after appendectomy on\nhistopathological examination. Bowel obstruction,\nbowel intussusception, bowel habit disturbance, cyclic\nacute abdominal symptoms, and positive occult blood\ntest/colonoscopy are other reported symptoms of AE.\nTimely, accurate imaging assessment is essential as\nendometriosis has a heterogeneous presentation and a\nsubstantial impact on quality of life (6-11).\nNoninvasive imaging methods such as transvaginal\nsonography (TVS) and magnetic resonance imaging\n(MRI) can help determine the exact location and spread\nof endometriosis. In addition, magnetic resonance\nenterography (MRE) can assist particularly in the\ndetection of bowel DIE and surgical planning in cases\nwith multiple lesions. Laparoscopic surgery is the\npreferred approach for surgical planning and treatment\nof endometriosis, and appendectomy may be performed\nwhen appendiceal involvement is suspected (5, 12-20).\nAccurate preoperative imaging assessment of\nsymptomatic AE is essential for selecting the most\nappropriate treatment through precise disease\nmapping. In this review, we focus on the imaging\nfindings of AE in symptomatic patients to highlight the\nutility of imaging modalities in timely and accurate\npreoperative diagnosis.\n2. O bjectives\nThe present systematic review aimed to review and\ncollect the imaging abnormalities associated with\nsymptomatic AE confirmed by histopathology, and to\ndescribe detection patterns by modality to aid in\npreoperative planning.\n3. Methods\n3.1. Study Design\nThis systematic review adhered to the preferred\nreporting items for systematic reviews and meta-\nanalyses (PRISMA) guidelines. Given the rarity of\nsymptomatic AE, we included case reports to capture\ndetailed imaging findings. Additionally, we aimed to\ninclude case series and observational studies to enhance\ndata richness, though no suitable comparative studies\nwere identified during screening.\n3.2. Search Strategy\nWe conducted a comprehensive literature search\nacross five databases: PubMed, Scopus, Web of Science,\nCINAHL Plus, and the Cochrane Library. The search\nincluded combinations of the following terms:\n\"appendix\", \"endometriosis\", \"magnetic resonance\nimaging\", \"transvaginal sonography\", and \"transrectal\nhigh-intensity focused ultrasound\". Boolean operators\nwere used to refine search queries. Filters were applied\nto include only English-language articles with full text\navailable, published up to 2024. The proposed search\nstrategy is as follows: PubMed (Title/Abstract):\n(“appendix” AND “endometriosis”) AND (MRI OR\n“magnetic resonance imaging”) OR (“transvaginal\nsonography”) OR (“transrectal high-intensity focused\nultrasound”)).\n3.3. Eligibility Criteria\nWe included studies that reported imaging findings\nin symptomatic patients diagnosed with AE and\nprovided histopathological confirmation of diagnosis.\nWe excluded randomized controlled trials, review\narticles, cohort studies, and systematic reviews,\nconference abstracts, non-English articles, and studies\nwithout full-text availability.\n3.4. Study Selection and Data Extraction\nTwo reviewers independently screened\ntitles/abstracts using Covidence software. Discrepancies\nwere resolved through discussion. Full-text articles of\npotentially relevant studies were reviewed to determine\n\nShakki Katouli F et al. Brieflands\nI J Radiol. 2025; 22(2): e142342 3\neligibility. Out of 494 initial records, 128 duplicates were\nremoved. After title and abstract screening, 323 records\nwere excluded. Following full-text review, 39 studies\n(comprising 40 cases) were included. Data extracted\nincluded study characteristics, patient demographics,\nimaging modalities used, imaging findings, and\ntreatment outcomes. Extracted data were managed\nusing Excel.\n3.5. Risk of Bias and Quality Assessm ent\nThe quality of included case reports was assessed\nusing the Joanna Briggs Institute (JBI) critical appraisal\nchecklist for case reports. Each case was evaluated for\ncompleteness in patient history, diagnostic methods,\nand outcome reporting. Risk of bias was considered\nbased on clarity of imaging interpretation, potential\nconfounding conditions, and consistency with\nhistopathological findings.\n3.6. Data Analysis\nGiven the nature of case reports, data were analyzed\ndescriptively. Frequencies and percentages were\ncalculated for imaging modalities and findings. No\nstatistical tests were conducted due to the absence of\ncomparative or quantitative data.\n3.7. Protocol Registration\nThis review was registered with PROSPERO\n(Registration No.: CRD42022335388) and approved by\nthe ethics committee (IR.TUMS.IKHC.REC.1401.094).\nThese steps ensure transparency, credibility, and\nadherence to ethical standards in the research process,\naligning with best practices in systematic reviews and\nacademic research as highlighted in the provided\nsources.\n4. Results\nFrom 39 studies, we identified 40 cases of\nsymptomatic AE with reported imaging findings. The\nmean patient age was 37.2 years (SD ± 7.07). Of the 40\npatients, 8 (20%) were pregnant. An overview of the\nincluded studies and patient characteristics is\nsummarized in Table 1.\n4.1. Clinical Presentation\nThe most frequent symptom was abdominal pain,\nparticularly in the RLQ, reported in 77.5% of cases. Other\ncommon symptoms included vomiting (42.5%), nausea\n(30%), abdominal tenderness (55%), and bowel\nobstruction (20%). Less frequent symptoms included\nbowel habit disturbance (10%), dysmenorrhea (15%), and\nfever (5%). The clinical symptoms observed among\npatients are detailed in Table 2.\nTable 2. Summary of Main Clinical Symptoms\nClinical sym ptom s No. (%)\nBowel obstruction 8 (20)\nBowel intussusception 2 (5)\nBowel habit disturbance 4 (10)\nCyclic sym ptom s 1 (2.5)\nAbdom inal pain 31 (77.5)\nPelvic pain 1 (2.5)\nAbdom inal tenderness 22 (55)\nAbdom inal distension 10 (25)\nGuarding 7 (17.5)\nFluid accum ulation 5 (12.5)\nDiarrhea 6 (15)\nConstipation 3 (7.5)\nNausea 12 (30)\nVom iting 17 (42.5)\nAnorexia 4 (10)\nFever 2 (5)\nLeukocytosis 11 (27.5)\nDysm enorrhea 6 (15)\nIrregular bleeding 4 (10)\n4.2. Im aging M odalities\n1. Computed tomography (n = 30): Positive findings\nwere seen in 26 patients (86.6%). Common findings\nincluded RLQ mass, appendiceal wall thickening, and\nascites or free fluid.\n2. Magnetic resonance imaging (n = 11): Positive\nfindings were seen in 7 patients (63.6%). Key features\nincluded RLQ mass with signal heterogeneity, wall\nthickening, and nodular lesions with T2 hypointensity.\n3. Ultrasound (n = 13): Positive findings were seen in 11\npatients (84.6%), identifying features like wall\nthickening, mass, and signs of intussusception.\nOf the 40 patients included in this review, 14\nunderwent more than one imaging modality, which\nenabled cross-modality comparison of findings in a\nsubset of cases.\n4.3. Com parative Im aging Trends\nAmong imaging findings:\n\nShakki Katouli F et al. Brieflands\n4 I J Radiol. 2025; 22(2): e142342\n- Right lower quadrant mass was most commonly\ndetected by MRI (54.54%) and CT (33.33%).\n- Appendiceal wall thickening was seen across all\nmodalities but most frequently in CT (26.67%).\n- Magnetic resonance imaging identified unique soft\ntissue characteristics, useful for differentiating\nendometriosis from other pathologies.\n- Sonography remained useful in initial assessment,\nespecially in pregnant patients.\nA comparative analysis of imaging findings across\nmodalities is shown in Table 3.\nTable 3. Detailed Comparison of Imaging Findings by Sonography, Computed\nTomography, and Magnetic Resonance Imaging a\nIm aging findings Sonography (n = 13) CT (n = 30) MRI (n = 11)\nWall thickening 3 (23.07) 8 (26.67) 1 (9.09)\nMass 2 (15.38) 10 (33.33) 6 (54.54)\nCystic m ass 0 (0.00) 0 (0.00) 0 (0.00)\nSolid lesion in the left ovary 0 (0.00) 1 (3.33) 0 (0.00)\nMucocele 1 (7.69) 2 (6.66) 1 (9.09)\nIntussusception 2 (15.38) 3 (10.00 2 (18.18)\nO bstruction 0 (0.00) 4 (13.33) 1 (9.09)\nSuspected bowel obstruction 0 (0.00) 1 (3.33) 0 (0.00)\nAppendicitis 1 (7.69) 2 (6.66) 0 (0.00)\nFluid 2 (15.38) 7 (23.33) 0 (0.00)\nAbscess 0 (0.00) 2 (6.66) 1 (9.09)\nAbbreviations: CT, computed tomography; MRI, magnetic resonance imaging.\na Values are expressed as No. (%).\n4.4. Interpretation\nAcross imaging techniques, RLQ mass and wall\nthickening emerged as the most consistent findings\nsuggestive of AE. The MRI, due to its soft tissue\nresolution, added value in identifying concurrent pelvic\nendometriosis lesions. These trends support MRI as the\nmodality of choice in complex or inconclusive cases,\nwhile CT remains the workhorse in acute settings.\nSonography complements both but is limited in\nspecificity. This synthesis improves our understanding\nof imaging findings in a rare condition and provides\nguidance for diagnosis and surgical planning.\n5. Discussion\nDespite advances in medical and surgical treatment,\nwomen with DIE experience significant impairment in\nquality of life (60). Endometriosis of the appendix\npresenting with acute appendicitis is rare and accounts\nfor less than 1% of all appendiceal pathologies that can\nresemble the clinical picture of acute appendicitis (61).\nPatients with cyclic bowel symptoms, chronic RLQ pain,\nand severe endometriosis are at a higher risk for\ndeveloping AE. However, in our study, only 55% of\npatients were known cases of endometriosis who\npresented with abdominal tenderness (62).\nDespite none of the patients having definitive\nimaging findings of endometriosis before surgery,\nretrospective evaluation of MRI in patients suggested\nfindings in favor of AE, including: Concomitant hypo-\nintense T1 and T2 nodularity along the terminal ileum\nserosal surface, hypo-intense T1 and T2 mass in the cecal\nbase and appendix orifice, and skipped DIE lesions in\nthe rectum and rectosigmoid. In 2023, Medeiros et al.\nconducted a systematic review on the accuracy of MRI\nfor DIE and reported that MRI has a high sensitivity and\nspecificity for the detection of intestinal endometriosis\n[pooled sensitivity of 0.84 (95% CI 0.78 - 0.88) and\nspecificity of 0.97 (95% CI 0.94 - 0.98)] (63). These\nfindings suggest that careful evaluation of pelvic MRI in\nwomen of reproductive age with RLQ symptoms could\nhelp suggest the preoperative imaging findings of AE\nand provide patients with benefits from non-surgical\ntreatments. It should be noted that in some conditions,\ndifferentiation of AE in nodular form is impossible from\na carcinoid tumor, and definitive diagnosis often relies\non surgical and histopathological findings.\nIn 2020, Aas-Eng et al. in Norway reviewed the\nliterature on endometriosis imaging, focusing on TVS\nand MRI for DIE and adenomyosis. The study suggested\nthat TVS and MRI are reliable methods for diagnosing\nendometriosis, adenomyosis, and especially DIE. The\ninformation obtained from these imaging methods can\nassist physicians in planning surgery and estimating its\nrisks. Therefore, the use of TVS and MRI should be the\nfirst step in the imaging findings and treatment of\nendometriosis patients (16).\nIn 2020, Indrielle-Kelly et al. conducted a prospective\nobservational study to investigate the accuracy of TVS\nand MRI in identifying pelvic DIE. The study included 49\nout of 111 patients who underwent imaging with these\ntwo methods to plan surgical treatment. Both methods\nhad similar sensitivity and specificity in identifying\nlesions of the upper rectum and rectosigmoid. The TVS\nhad lower sensitivity and more specificity than MRI in\nevaluating the bladder, uterosacral ligament, vagina,\n\nShakki Katouli F et al. Brieflands\nI J Radiol. 2025; 22(2): e142342 5\nrectovaginal septum, and pelvis in general. MRI was\nsignificantly superior to TVS in identifying lesions in the\nuterosacral ligament. The study concluded that the use\nof both methods is useful in identifying pelvic DIE (62).\nBazot et al. conducted a study in 2020 to review the\nuse of MRI in diagnosing DIE involving the small\nintestine, including its protocols, indications, technical\nrequirements, patient preparation, and criteria.\nAccording to the study, MRI should be used as the\nsecond-line tool after TVS for evaluating endometriosis\nin the rectosigmoid colon. It is also recommended to\nuse MRI before surgery to determine the stage of the\ndisease. In addition, MR-enterography should be\nperformed to check for ileocecal and appendicular\nlesions (63).\nThe RLQ mass and appendiceal wall thickening were\nthe most common imaging findings in our review. In\naddition, RLQ mass was the most frequent MRI finding.\nAlthough the exact prevalence and accuracy of imaging\nfindings in AE are not defined in the literature, the\nreported imaging findings include: An enlarged\nappendix involved by hypodense soft tissue masses,\nluminal dilation or focal nodules within the\nappendiceal body in CT, and discrete serosal\nhyperintense foci on pre-contrast fat-saturated T1\nimages to nodular lesions that appear hypointense on\nT2 images, occupying the tip or body of the appendix,\nluminal obstruction resembling an appendiceal\nmucocele on MRI (64).\nThe imaging findings of AE causing acute\nappendicitis can be challenging, as it is often mistaken\nfor other diseases. In cases of acute appendicitis, the\nexact cause is not always clear but is often attributed to\ninfection or obstruction. Although endometriosis is a\nrelatively common disease in women of reproductive\nage, isolated involvement of the appendix is rare. The\nresults of our study suggest that CT and MRI are the\npreferred modalities for detecting RLQ pathologies in\npatients with underlying endometriosis, particularly\nMRI because of the higher soft tissue resolution and\nability to detect concomitant endometriotic lesions in\nboth pelvic and extrapelvic locations (65). The RLQ mass,\nbowel intussusception, mucocele, and bowel wall\nthickening were the most prevalent reported findings in\nMRI (66). The bowel wall thickening, obstruction,\nappendicitis, and free fluid were the most prevalent\nreported findings in CT.\nA major limitation of our review is the absence of\neligible observational studies or case series, primarily\ndue to the rarity of symptomatic AE, which reduces the\ngeneralizability and strength of the synthesized\nfindings. Our systematic search did not identify any\nanalytical studies containing sufficient cases for\ninclusion. Even hypothetically, if such studies existed,\ntheir descriptive findings would likely focus broadly on\nclinical outcomes rather than detailed imaging-specific\ndata, potentially introducing heterogeneity and\ninterpretational bias.\nIn conclusion, RLQ mass and bowel wall thickening\nare the most commonly reported findings in patients\nwith AE. The MRI appears to be a useful modality in\npatients suspected of appendicitis and has the added\nbenefit of detecting other foci of pelvic or abdominal\nendometriosis. We recommend the use of MRI in clinical\nsettings where endometriosis complications are\nsuspected. Further studies are required to\nretrospectively evaluate the imaging findings of the\nappendix in pathologically confirmed AE, particularly in\npatients undergoing pelvic surgery.\nFootnotes\nAuthors' Contribution: F. S. K. conceived and\ndesigned the assessments and drafted the manuscript. S.\nT. participated in designing the assessments and\ncontributed to the statistical analysis and drafting of the\nmanuscript. A. A. and R. Y. re-evaluated the clinical data,\nrevised the manuscript, performed statistical analysis,\nand revised the manuscript. P. R. F., F. A., L. B., and H. Q.\ncollected and interpreted the clinical data. J. Z. and F. S.\nK. re-analyzed the clinical and statistical data and\nrevised the manuscript. All authors read and approved\nthe final manuscript.\nConflict of Interests Statem ent: The authors declare\nno conflict of interests.\nData Availability: The protocol registration number\nfor the study is CRD42022335388 on PROSPERO, a key\nplatform for registering systematic reviews.\nEthical Approval: The present study received approval\nfrom the ethics committee with the reference number\nof IR.TUMS.IKHC.REC.1401.094 .\n\nShakki Katouli F et al. Brieflands\n6 I J Radiol. 2025; 22(2): e142342\nFunding/Support: The present study received no\nfunding/support.\nReferences\n1. Andres MP, Arcoverde FVL, Souza CCC, Fernandes LFC, Abrao MS, Kho\nRM. Extrapelvic Endometriosis: A Systematic Review. J M inim  Invasive\nGynecol. 2020;27(2):373-89. [PubMed ID: 31618674].\nhttps://doi.org/10.1016/j.jmig.2019.10.004.\n2. Tomassetti C, Johnson NP, Petrozza J, Abrao MS, International\nWorking Group of Aagl EE; Esge Eshre Wes. An International\nTerminology for Endometriosis, 2021. Facts Views Vis Obgyn.\n2021;13(4):295-304. [PubMed ID: 34672510]. [PubMed Central ID:\nPMC9148705]. https://doi.org/10.52054/FVVO.13.4.036.\n3. Yovich JL, Rowlands PK, Lingham S, Sillender M, Srinivasan S.\nPathogenesis of endometriosis: Look no further than John Sampson.\nReprod Biom ed Online. 2020;40(1):7-11. [PubMed ID: 31836436].\nhttps://doi.org/10.1016/j.rbmo.2019.10.007.\n4. Mabrouk M, Raimondo D, Mastronardi M, Raimondo I, Del Forno S,\nArena A, et al. Endometriosis of the Appendix: When to Predict and\nHow to Manage-A Multivariate Analysis of 1935 Endometriosis Cases. J\nM inim  Invasive Gynecol. 2020;27(1):100-6. [PubMed ID: 30849476].\nhttps://doi.org/10.1016/j.jmig.2019.02.015.\n5. Allahqoli L, Mazidimoradi A, Momenimovahed Z, Gunther V,\nAckermann J, Salehiniya H, et al. Appendiceal Endometriosis: A\nComprehensive Review of the Literature. Diagnostics (Basel).\n2023;13(11). [PubMed ID: 37296678]. [PubMed Central ID:\nPMC10253163]. https://doi.org/10.3390/diagnostics13111827.\n6. Berlanda N, Somigliana E, Frattaruolo MP, Buggio L, Dridi D,\nVercellini P. Surgery versus hormonal therapy for deep\nendometriosis: is it a choice of the physician? Eur J Obstet Gynecol\nReprod Biol. 2017;209:67-71. [PubMed ID: 27544308].\nhttps://doi.org/10.1016/j.ejogrb.2016.07.513.\n7. Rolla E. Endometriosis: advances and controversies in classification,\npathogenesis, diagnosis, and treatment. F1000Res. 2019;8. [PubMed\nID: 31069056]. [PubMed Central ID: PMC6480968].\nhttps://doi.org/10.12688/f1000research.14817.1.\n8. Okeke TC, Ikeako LC, Ezenyeaku CC. Endometriosis. Niger J M ed.\n2011;20(2):191-9.\n9. Moulder JK, Siedhoff MT, Melvin KL, Jarvis EG, Hobbs KA, Garrett J.\nRisk of appendiceal endometriosis among women with deep-\ninfiltrating endometriosis. Int J Gynaecol Obstet. 2017;139(2):149-54.\n[PubMed ID: 28755505]. https://doi.org/10.1002/ijgo.12286.\n10. Taylor HS. Endometriosis: a complex systemic disease with multiple\nmanifestations. Fertil Steril. 2019;112(2):235-6. [PubMed ID: 31280952].\nhttps://doi.org/10.1016/j.fertnstert.2019.06.006.\n11. Chen RJ, Kerdemelidis P, Wijeratne S. Appendiceal endometriosis: a\nchallenging diagnosis. ANZ  J Surg. 2020;90(9):1810-2. [PubMed ID:\n31943679]. https://doi.org/10.1111/ans.15699.\n12. Jeong DH, Jeon H, Adkins K. Appendiceal endometriosis: a greater\nmimicker of appendicitis. Hong Kong M ed J. 2019;25(6):492-3.\n[PubMed ID: 32127505]. https://doi.org/10.12809/hkmj187654.\n13. Feldhaus DJ, Harris RK, Dayal SD. Appendiceal Endometriosis\nPresenting as Possible Cecal Mass. Am  Surg. 2020;86(11):1528-30.\n[PubMed ID: 32683922]. https://doi.org/10.1177/0003134820933606.\n14. Shen AY, Stanes A. Isolated Appendiceal Endometriosis. J Obstet\nGynaecol Can. 2016;38(10):979-81. [PubMed ID: 27720099].\nhttps://doi.org/10.1016/j.jogc.2016.06.006.\n15. Parra RS, Feitosa MR, Biagi GBB, Brandao DF, Moraes M, Silvestre L, et\nal. Neuroendocrine appendiceal tumor and endometriosis of the\nappendix: a case report. J M ed Case Rep. 2020;14(1):152. [PubMed ID:\n32921300]. [PubMed Central ID: PMC7489048].\nhttps://doi.org/10.1186/s13256-020-02490-x.\n16. Aas-Eng MK, Montanari E, Lieng M, Keckstein J, Hudelist G.\nTransvaginal Sonographic Imaging and Associated Techniques for\nDiagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A\nComprehensive Review. Sem in Reprod M ed. 2020;38(2-03):216-26.\n[PubMed ID: 33232986]. https://doi.org/10.1055/s-0040-1718740.\n17. Mittal KR, Thornton CT, Tamirisa NP. Endometriosis of the appendix:\ncomprehensive review of literature. J Surg Educ. 2006;63:395-9.\n18. Logman I, Westergaard JG, Graversen HP. Endometriosis foci in the\nmuscle, serosa, and subserosa of the subserous area. Fertil Steril.\n1988;49:654-7.\n19. Yela DA, Quagliato IP, Benetti-Pinto CL. Quality of Life in Women with\nDeep Endometriosis: A Cross-Sectional Study. Rev Bras Ginecol Obstet.\n2020;42(2):90-5. [PubMed ID: 32227324]. [PubMed Central ID:\nPMC10316839]. https://doi.org/10.1055/s-0040-1708091.\n20. Emre A, Akbulut S, Yilmaz M, Bozdag Z. An unusual cause of acute\nappendicitis: Appendiceal endometriosis. Int J Surg Case Rep.\n2013;4(1):54-7. [PubMed ID: 23124069]. [PubMed Central ID:\nPMC3537945]. https://doi.org/10.1016/j.ijscr.2012.07.018.\n21. Akagi T, Yamamoto S, Kobayashi Y, Fujita S, Akasu T, Moriya Y, et al. A\ncase of endometriosis of the appendix with adhesion to right\novarian cyst presenting as intussusception of a mucocele of the\nappendix. Surg Laparosc Endosc Percutan Tech. 2008;18(6):622-5.\n[PubMed ID: 19098675]. https://doi.org/10.1097/SLE.0b013e318180f67f.\n22. Teiga E, Radosevic A, Sánchez J, Busto M, Aguilar G, Maiques J, et al. A\nrare case of right lower quadrant pain. BJR Case Rep. 2019;5(2).\nhttps://doi.org/10.1259/bjrcr.20170024.\n23. Drumond JPN, de Melo ALA, Germini DE, Morrell AC. Acute\nAppendicitis Secondary to Appendiceal Endometriosis. Case Rep Surg.\n2020;2020:8813184. [PubMed ID: 33101752]. [PubMed Central ID:\nPMC7569452]. https://doi.org/10.1155/2020/8813184.\n24. Slesser AA, Sultan S, Kubba F, Sellu DP. Acute small bowel obstruction\nsecondary to intestinal endometriosis, an elusive condition: a case\nreport. W orld J Em erg Surg. 2010;5:27. [PubMed ID: 20846366].\n[PubMed Central ID: PMC2949747]. https://doi.org/10.1186/1749-7922-5-\n27.\n25. Al-Talib A. Appendiceal Endometriosis. Saudi Journal of M edicine and\nM edical Sciences. 2013;1(2). https://doi.org/10.4103/1658-631x.123645.\n26. Lebastchi AH, Prieto PA, Chen C, Lui FY. Appendiceal endometriosis in\na pregnant woman presenting with acute perforated appendicitis. J\nSurg Case Rep. 2013;2013(12). [PubMed ID: 24968435]. [PubMed Central\nID: PMC3888003]. https://doi.org/10.1093/jscr/rjt104.\n27. Lainas P, Dammaro C, Rodda GA, Morcelet M, Prevot S, Dagher I.\nAppendiceal endometriosis invading the sigmoid colon: a rare\nentity. Int J Colorectal Dis. 2019;34(6):1147-50. [PubMed ID: 30666405].\nhttps://doi.org/10.1007/s00384-019-03242-0.\n28. Lopez MPJ, Chan V, Melendres MF, Lutanco R. Appendiceal\nintussusception from endometriosis. BM J Case Rep. 2021;14(6).\n[PubMed ID: 34158326]. [PubMed Central ID: PMC8220524].\nhttps://doi.org/10.1136/bcr-2021-241592.\n\nShakki Katouli F et al. Brieflands\nI J Radiol. 2025; 22(2): e142342 7\n29. Marin MR, Parra Banos PA, Gonzalez Valverde FM, Moncada JR, Arenas\nMFC, Martinez MM, et al. Appendiceal Intussusception Resulting\nfrom Endometriosis Presenting as Acute Appendicitis. Am  Surg.\n2010;76(8):906-8. [PubMed ID: 28958241].\n30. Trefois C, Coche E. Appendiceal Intussusception Secondary to\nEndometriosis: A Rare Etiology of Right Lower Quadrant Abdominal\nPain. J Belg Soc Radiol. 2022;106(1):34. [PubMed ID: 35600761].\n[PubMed Central ID: PMC9075099]. https://doi.org/10.5334/jbsr.2739.\n31. Gupta AK, Mann A, Belizon A. Appendicitis Caused by Endometriosis\nWithin the Bowel Wall. Cureus. 2020.\nhttps://doi.org/10.7759/cureus.9614.\n32. Bekki T, Fukuda T, Moriuchi T, Namba Y, Okimoto S, Mukai S, et al.\nAppendicitis with submucosal fecalith mimicking a submucosal\ntumor: a case report. Surg Case Rep. 2021;7(1):105. [PubMed ID:\n33905033]. [PubMed Central ID: PMC8079595].\nhttps://doi.org/10.1186/s40792-021-01169-9.\n33. Basso MP, Christiano AB, Oliveira ALCD, Cunrath GS, Netinho JG.\nAppendicular endometriosis as a cause of chronic abdominal pain\nalone in the right iliac fossa: case report and literature review. J\nColoproctol (Rio de Janeiro). 2012;32(1):79-82.\nhttps://doi.org/10.1590/s2237-93632012000100012.\n34. Gupta R, Singh AK, Farhat W, Ammar H, Azzaza M, Mizouni A, et al.\nAppendicular endometriosis: A case report and review of literature.\nInt J Surg Case Rep. 2019;64:94-6. [PubMed ID: 31622934]. [PubMed\nCentral ID: PMC6796600]. https://doi.org/10.1016/j.ijscr.2019.07.046.\n35. Alizadeh Otaghvar H, Hosseini M, Shabestanipour G, Tizmaghz A,\nSedehi Esfahani G. Cecal endometriosis presenting as acute\nappendicitis. Case Rep Surg. 2014;2014:519631. [PubMed ID: 25126441].\n[PubMed Central ID: PMC4120490].\nhttps://doi.org/10.1155/2014/519631.\n36. Hakoda K, Yoshimitsu M, Miguchi M, Kohashi T, Egi H, Ohdan H, et al.\nCharacteristic findings of appendicular endometriosis treated with\nsingle incision laparoscopic ileocolectomy: Case report. Int J Surg\nCase Rep. 2020;67:9-12. [PubMed ID: 31991379]. [PubMed Central ID:\nPMC7076268]. https://doi.org/10.1016/j.ijscr.2019.12.039.\n37. Nojkov B, Duffy MC, Amin M, Cappell MS. Colonic endometriosis\npresenting as a sigmoid stricture requiring laparoscopic colonic\nsurgery for diagnosis and treatment. Dig Dis Sci. 2013;58(11):3368-73.\n[PubMed ID: 23907335]. https://doi.org/10.1007/s10620-013-2771-1.\n38. Millochau JC, Abo C, Darwish B, Huet E, Dietrich G, Roman H.\nContinuous Amenorrhea May Be Insufficient to Stop the Progression\nof Colorectal Endometriosis. J M inim  Invasive Gynecol. 2016;23(5):839-\n42. [PubMed ID: 27130533]. https://doi.org/10.1016/j.jmig.2016.04.008.\n39. Tsunemitsu A, Tsutsumi T, Ikura Y. Deciduosis of the Appendix\nDuring Pregnancy. Intern M ed. 2021;60(10):1641-4. [PubMed ID:\n33361675]. [PubMed Central ID: PMC8188025].\nhttps://doi.org/10.2169/internalmedicine.5960-20.\n40. Curbelo-Pena Y, Guedes-De la Puente X, Saladich-Cubero M, Molinas-\nBruguera J, Molineros J, De Caralt-Mestres E. Endometriosis causing\nacute appendicitis complicated with hemoperitoneum. J Surg Case\nRep. 2015;2015(8). [PubMed ID: 26253154]. [PubMed Central ID:\nPMC4528180]. https://doi.org/10.1093/jscr/rjv097.\n41. Choi JDW, Yunaev M. Endometriosis of the appendix causing small\nbowel obstruction in a virgin abdomen. BM J Case Rep. 2019;12(7).\n[PubMed ID: 31337629]. [PubMed Central ID: PMC6663186].\nhttps://doi.org/10.1136/bcr-2019-230496.\n42. Khairy GA. Endometriosis of the appendix: a trap for the unwary.\nSaudi J Gastroenterol. 2005;11(1):45-7. [PubMed ID: 19861847].\nhttps://doi.org/10.4103/1319-3767.33337.\n43. Zhu MY, Fei FM, Chen J, Zhou ZC, Wu B, Shen YY. Endometriosis of the\nduplex appendix: A case report and review of the literature. W orld J\nClin Cases. 2019;7(15):2094-102. [PubMed ID: 31423443]. [PubMed\nCentral ID: PMC6695541]. https://doi.org/10.12998/wjcc.v7.i15.2094.\n44. Karaman K, Pala EE, Bayol U, Akman O, Olmez M, Unluoglu S, et al.\nEndometriosis of the terminal ileum: a diagnostic dilemma. Case Rep\nPathol. 2012;2012:742035. [PubMed ID: 22997597]. [PubMed Central ID:\nPMC3446655]. https://doi.org/10.1155/2012/742035.\n45. Terada T. Endometriosis of the Vermiform Appendix Presenting as a\nTumor. Gastroenterol Res. 2009;2(6):353.\nhttps://doi.org/10.4021/gr2009.12.1330.\n46. Alatise OI, Sabageh D, Ogunniyi SO, Olaofe OO. Ileal endometriosis\npresenting as acute small intestinal obstruction: a case report. W est\nAfr J M ed. 2010;29(5):352-5. [PubMed ID: 21089025].\n47. Yaghi M, Nassar H, Zadeh C, Faraj W. Incidental appendiceal mass as\nthe only manifestation of endometriosis. BM J Case Rep. 2021;14(2).\n[PubMed ID: 33619136]. [PubMed Central ID: PMC7903092].\nhttps://doi.org/10.1136/bcr-2020-239090.\n48. Zenger S, Bilgic C, Bugra D. Laparoscopic partial cecum resection in\nappendiceal intussusception. Turk J Surg. 2019;35(1):74-7. [PubMed ID:\n32550307]. [PubMed Central ID: PMC6791683].\nhttps://doi.org/10.5578/turkjsurg.3633.\n49. Lee WY, Noh JH. Leiomyomatosis peritonealis disseminata associated\nwith appendiceal endometriosis: a case report. J M ed Case Rep.\n2015;9:167. [PubMed ID: 26215629]. [PubMed Central ID: PMC4532259].\nhttps://doi.org/10.1186/s13256-015-0637-1.\n50. Tsuda M, Yamashita Y, Azuma S, Akamatsu T, Seta T, Urai S, et al.\nMucocele of the appendix due to endometriosis: a rare case report.\nW orld J Gastroenterol. 2013;19(30):5021-4. [PubMed ID: 23946611].\n[PubMed Central ID: PMC3740436].\nhttps://doi.org/10.3748/wjg.v19.i30.5021.\n51. Porter J, Eisdorfer J, Yi C, Nguyen C. Multifocal abdominal\nendometriosis, a case report. J Surg Case Rep. 2020;2020(6):rjaa120.\n[PubMed ID: 32595921]. [PubMed Central ID: PMC7303103].\nhttps://doi.org/10.1093/jscr/rjaa120.\n52. Morotti M, Camerini G, Biscaldi E, Remorgida V, Ferrero S. Pre-\nOperative Evaluation of an Appendiceal Mucocele in a Woman with\nEndometriosis. J Endom etriosis Pelvic Pain Disorders. 2013;5(3):120-2.\nhttps://doi.org/10.5301/je.5000160.\n53. Shichiri K, Nishida K, Lefor AK, Kubota T. Preoperative hormonal\ntherapy for a patient with appendiceal endometriosis. BM J Case Rep.\n2021;14(11). [PubMed ID: 34764095]. [PubMed Central ID:\nPMC8587620]. https://doi.org/10.1136/bcr-2021-245667.\n54. How R, Wikiel KJ, Hamad GG. Right lower quadrant pain during\npregnancy. JAM A Surg. 2014;149(5):489-90. [PubMed ID: 24671308].\nhttps://doi.org/10.1001/jamasurg.2013.1686.\n55. Miyakura Y, Kumano H, Horie H, Lefor AT, Yasuda Y, Yamaguchi T, et\nal. Rupture of appendiceal mucocele due to endometriosis: report of\na case. Clin J Gastroenterol. 2012;5(3):220-4. [PubMed ID: 26182324].\nhttps://doi.org/10.1007/s12328-012-0302-9.\n56. Kobayashi K, Yamadera M, Takeo H, Murayama M. Small bowel\nobstruction caused by appendiceal and ileal endometriosis: a case\nreport. J Surg Case Rep. 2022;2022(6):rjac282. [PubMed ID: 35721264].\n\nShakki Katouli F et al. Brieflands\n8 I J Radiol. 2025; 22(2): e142342\n[PubMed Central ID: PMC9200432].\nhttps://doi.org/10.1093/jscr/rjac282.\n57. Koyama R, Aiyama T, Yokoyama R, Nakano S. Small Bowel\nObstruction Caused by Ileal Endometriosis with Appendiceal and\nLymph Node Involvement Treated with Single-Incision Laparoscopic\nSurgery: A Case Report and Review of the Literature. Am  J Case Rep.\n2021;22. e930141. [PubMed ID: 33755660]. [PubMed Central ID:\nPMC8006474]. https://doi.org/10.12659/AJCR.930141.\n58. Sali PA, Yadav KS, Desai GS, Bhole BP, George A, Parikh SS, et al. Small\nbowel obstruction due to an endometriotic ileal stricture with\nassociated appendiceal endometriosis: A case report and systematic\nreview of the literature. Int J Surg Case Rep. 2016;23:163-8. [PubMed ID:\n27153232]. [PubMed Central ID: PMC5022069].\nhttps://doi.org/10.1016/j.ijscr.2016.04.025.\n59. Iwamuro M, Tanaka T, Sugihara Y, Harada K, Hiraoka S, Kondo Y, et al.\nTwo Cases of Endometriosis in the Cecum Detected by Contrast-\nenhanced Computed Tomography with Air/Carbon Dioxide\nInsufflation. Intern M ed. 2021;60(11):1697-701. [PubMed ID: 33390498].\n[PubMed Central ID: PMC8222140].\nhttps://doi.org/10.2169/internalmedicine.6418-20.\n60. Chamie LP, Ribeiro D, Tiferes DA, Macedo Neto AC, Serafini PC.\nAtypical Sites of Deeply Infiltrative Endometriosis: Clinical\nCharacteristics and Imaging Findings. Radiographics. 2018;38(1):309-\n28. [PubMed ID: 29320327]. https://doi.org/10.1148/rg.2018170093.\n61. Medeiros LR, Rosa MI, Silva BR, Reis ME, Simon CS, Dondossola ER, et\nal. Accuracy of magnetic resonance in deeply infiltrating\nendometriosis: a systematic review and meta-analysis. Arch Gynecol\nObstet. 2015;291(3):611-21. [PubMed ID: 25288268].\nhttps://doi.org/10.1007/s00404-014-3470-7.\n62. Indrielle-Kelly T, Fruhauf F, Fanta M, Burgetova A, Lavu D, Dundr P, et\nal. Diagnostic Accuracy of Ultrasound and MRI in the Mapping of\nDeep Pelvic Endometriosis Using the International Deep\nEndometriosis Analysis (IDEA) Consensus. Biom ed Res Int.\n2020;2020:3583989. [PubMed ID: 32083128]. [PubMed Central ID:\nPMC7011347]. https://doi.org/10.1155/2020/3583989.\n63. Bazot M, Kermarrec E, Bendifallah S, Darai E. MRI of intestinal\nendometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:51-63.\n[PubMed ID: 32653334]. https://doi.org/10.1016/j.bpobgyn.2020.05.013.\n64. Guerriero S, Saba L, Pascual MA, Ajossa S, Rodriguez I, Mais V, et al.\nTransvaginal ultrasound vs magnetic resonance imaging for\ndiagnosing deep infiltrating endometriosis: systematic review and\nmeta-analysis. Ultrasound Obstet Gynecol. 2018;51(5):586-95. [PubMed\nID: 29154402]. https://doi.org/10.1002/uog.18961.\n65. Chaar CI, Wexelman B, Zuckerman K, Longo W. Intussusception of\nthe appendix: comprehensive review of the literature. Am  J Surg.\n2009;198(1):122-8. [PubMed ID: 19249733].\nhttps://doi.org/10.1016/j.amjsurg.2008.08.023.\n66. de Bree E, Schoretsanitis G, Melissas J, Christodoulakis M, Tsiftsis D.\nAcute intestinal obstruction caused by endometriosis mimicking\nsigmoid carcinoma. Acta Gastroenterol Belg. 1998;61(3):376-8. [PubMed\nID: 9795475].\n\nShakki Katouli F et al. Brieflands\nI J Radiol. 2025; 22(2): e142342 9\nTable 1. Characteristics of Included Case Reports of Appendiceal Endometriosis a\nNo Article title Country First author Patient\nage Clinical characteristics\nReasons for inclusion in\nthis review (case\nfeatures)\nPregnancy\nstatus\n1\nA Case of Endometriosis of the Appendix with\nAdhesion to Right Ovarian Cyst Presenting as\nIntussusception of a Mucocele of the Appendix\nJapan Akagi (21) 35 Intussusception, ovarian\ncyst adhesion\nSymptomatic AE,\nintussusception No\n2 A Rare Case of Lower Quadrant Pain Portugal Eduardo (22) 40 RLQ pain Symptomatic AE, RLQ pain No\n3 Acute Appendicitis Secondary to Appendiceal\nEndometriosis Brazil Drumond (23) 32 Acute appendicitis Symptomatic AE, acute\nappendicitis No\n4\nAcute Small Bowel Obstruction Secondary to\nIntestinal Endometriosis, an Elusive Condition: A\nCase Report\nUnited\nKingdom Slesser (24) 33 Small bowel obstruction Symptomatic AE, small\nbowel obstruction No\n5 Appendiceal Endometriosis Saudi ArabiaA. Al-Talib (25) 31 Endometriosis of the\nappendix\nSymptomatic AE,\nabdominal pain No\n6 Appendiceal Endometriosis in a Pregnant Woman\nPresenting with Acute Perforated Appendicitis\nUnited\nStates Lebastchi (26) 33 Acute perforated\nappendicitis\nSymptomatic AE, acute\nperforated appendicitis Yes\n7 Appendiceal Endometriosis Invading the Sigmoid\nColon: A Rare Entity France Lainas (27) 41 Endometriosis invading\nsigmoid colon\nSymptomatic AE, sigmoid\ncolon involvement No\n8 Appendiceal Intussusception from Endometriosis PhilippinesLopez (28) 39 Intussusception due to\nendometriosis\nSymptomatic AE,\nintussusception No\n9 Appendiceal Intussusception Resulting from\nEndometriosis Presenting as Acute Appendicitis Spain Marin (29) 29 Acute appendicitis due to\nintussusception\nSymptomatic AE, acute\nappendicitis No\n10\nAppendiceal Intussusception Secondary to\nEndometriosis: A Rare Etiology of Right Lower\nQuadrant Abdominal Pain\nBelgium Trefois (30) 30 RLQ pain Symptomatic AE, RLQ pain No\n11 Appendicitis Caused by Endometriosis Within the\nBowel Wall\nUnited\nStates Gupta (31) 36 Appendicitis due to bowel\nwall endometriosis\nSymptomatic AE,\nappendicitis No\n12 Appendicitis with Submucosal Fecalith Mimicking\na Submucosal Tumor: A Case Report Japan Bekki (32) 40 Submucosal fecalith Symptomatic AE,\nappendicitis No\n13\nAppendicular Endometriosis as a Cause of Chronic\nAbdominal Pain Alone in the Right Iliac Fossa:\nCase Report and Literature Review\nBrazil Basso (33) 44 Chronic abdominal pain Symptomatic AE, chronic\nabdominal pain No\n14 Appendicular Endometriosis: A Case Report and\nReview of Literature India Gupta (34) 35 Endometriosis of the\nappendix\nSymptomatic AE,\nabdominal pain No\n15 Cecal Endometriosis Presenting as Acute\nAppendicitis Iran Alizadeh\nOtaghvar (35) 43 Acute appendicitis Symptomatic AE, acute\nappendicitis No\n16\nCharacteristic Findings of Appendicular\nEndometriosis Treated with Single Incision\nLaparoscopic Ileocolectomy: Case Report\nJapan Hakoda (36) 51\nLaparoscopic treatment of\nappendicular\nendometriosis\nSymptomatic AE,\nlaparoscopic findings No\n17\nColonic Endometriosis Presenting as a Sigmoid\nStricture Requiring Laparoscopic Colonic Surgery\nfor Diagnosis and Treatment\nUnited\nStates Nojkov (37) 29 Sigmoid stricture due to\nendometriosis\nSymptomatic AE, sigmoid\nstricture No\n18 Continuous Amenorrhea May Be Insufficient to\nStop the Progression of Colorectal Endometriosis France Millochau (38) 26 Amenorrhea related to\nendometriosis\nSymptomatic AE,\namenorrhea No\n19 Deciduosis of the Appendix During Pregnancy Japan Tsunemitsu\n(39) 35 Deciduosis during\npregnancy\nSymptomatic AE,\npregnancy-related\nsymptoms\nYes\n20 Endometriosis Causing Acute Appendicitis\nComplicated with Hemoperitoneum Spain Curbelo (40) 39 Acute appendicitis with\nhemoperitoneum\nSymptomatic AE, acute\nappendicitis No\n21 Endometriosis of the Appendix Causing Small\nBowel Obstruction in a Virgin Abdomen Australia Choi (41) 29 Small bowel obstruction Symptomatic AE, bowel\nobstruction No\n22 Endometriosis of the Appendix: A Trap for the\nUnwary Saudi ArabiaKhairy (42) 33 Endometriosis of the\nappendix\nSymptomatic AE,\nabdominal pain No\n23 Endometriosis of the Duplex Appendix: A Case\nReport and Review of the Literature China Zhu (43) 44 Duplex appendix with\nendometriosis\nSymptomatic AE, duplex\nappendix No\n24 Endometriosis of the Terminal Ileum: A Diagnostic\nDilemma Turkey Karaman (44) 27 Diagnostic challenges in\nterminal ileum\nSymptomatic AE, ileal\nsymptoms No\n25 Endometriosis of the Vermiform Appendix\nPresenting as a Tumor Japan Terada (45) 41 Tumor-like presentation of\nAE\nSymptomatic AE, tumor-\nlike symptoms No\n26 Ileal Endometriosis Presenting as Acute Small\nIntestinal Obstruction: A Case Report Nigeria Alatise (46) 34 Small intestinal obstructionSymptomatic AE,\nintestinal obstruction No\n27 Incidental Appendiceal Mass as the Only\nManifestation of Endometriosis Lebanon Yaghi (47). 34 Incidental finding of\nappendiceal mass\nSymptomatic AE,\nincidental findings No\n28 Laparoscopic Partial Cecum Resection in\nAppendiceal Intussusception Turkey Zenger (48) 35 Laparoscopic treatment of\nintussusception\nSymptomatic AE,\nintussusception No\n29 Leiomyomatosis Peritonealis Disseminata\nAssociated\n\nShakki Katouli F et al. Brieflands\n10 I J Radiol. 2025; 22(2): e142342\nNo Article title Country First\nauthor\nPatient\nage Clinical characteristics\nReasons for inclusion\nin this review (case\nfeatures)\nPregnancy\nstatus\nwith Appendiceal Endometriosis: A Case Report South\nKorea Lee (49) 31 Endometriosis with\nleiomyomatosis\nSymptomatic AE,\nleiomyomatosis No\n30 Mucocele of the Appendix due to Endometriosis: A Rare Case\nReport Japan Tsuda (50) 43 Appendiceal mucocele Symptomatic AE,\nmucocele No\n31 Multifocal Abdominal Endometriosis: A Case Report United\nStates Porter (51) 52 Multifocal presentation\nof endometriosis\nSymptomatic AE,\nmultifocal symptoms No\n32 Preoperative Evaluation of an Appendiceal Mucocele in a\nWoman with Endometriosis Italy Morotti\n(52) 35 Preoperative assessment\nof mucocele\nSymptomatic AE,\nmucocele assessment No\n33 Preoperative Hormonal Therapy for a Patient With\nAppendiceal Endometriosis Japan Shichiri\n(53) 40 Hormonal therapy prior\nto surgery\nSymptomatic AE,\nhormonal therapy No\n34 Lower Quadrant Pain During Pregnancy United\nStates How (54) 26 RLQ pain during\npregnancy\nSymptomatic AE,\npregnancy-related pain Yes\n35 Rupture of Appendiceal Mucocele due to Endometriosis:\nReport of a Case Japan Miyakura\n(55) 56 Ruptured appendiceal\nmucocele\nSymptomatic AE,\nruptured mucocele No\n36 Small Bowel Obstruction Caused by Appendiceal and Ileal\nEndometriosis: A Case Report Japan Kobayashi\n(56) 37 Small bowel obstruction\ndue to endometriosis\nSymptomatic AE, bowel\nobstruction No\n37\nSmall Bowel Obstruction Caused by Ileal Endometriosis\nwith Appendiceal and Lymph Node Involvement Treated\nwith Single-Incision Laparoscopic Surgery: A Case Report\nand Review of the Literature\nJapan Koyama\n(57) 40\nSmall bowel obstruction\nwith lymph node\ninvolvement\nSymptomatic AE, lymph\nnode involvement No\n38\nSmall Bowel Obstruction due to an Endometriotic Ileal\nStricture with Associated Appendiceal Endometriosis: A\nCase Report and Systematic Review of the Literature\nIndia Sali (58) 44 Endometriotic ileal\nstricture\nSymptomatic AE, ileal\nstricture No\n39\nTwo Cases of Endometriosis in the Cecum Detected by\nContrast-Enhanced Computed Tomography with Air/Carbon\nDioxide Insufflation\nJapan Iwamuro\n(59)\n40 and\n40\nEndometriosis in the\ncecum\nSymptomatic AE, cecal\nsymptoms No\nAbbreviations: AE, appendiceal endometriosis; RLQ, right lower quadrant.\na Because all included items are case reports, study-level inclusion criteria do not apply. This table lists review-level eligibility (symptomatic AE, histopathologic\nconfirmation, and sufficient clinical/imaging/surgical detail). No exclusion criteria were prespecified; all case reports meeting these features were included.","source_license":"CC0","license_restricted":false}