IMAGE OF THE MONTH

A 32-year-old woman presented with primary infertility,dysmenorrhea, and debilitating dyspareunia. She had a history of bowel symptoms previously diagnosed as irritable bowel syndrome. At subsequent laparoscopy, the appendix had a distinctive appearance (Figure). This dysmorphic “hockey-stick ” appendix, with a curved distal end, is often found at laparoscopy in women with endometriosis. Appendectomy was performed, and histologic evaluation of the specimen revealed typical evidence of endometriosis of the appendix. No preoperative symptom or clinical finding predicts involvement of the appendix in women with endometriosis.1 The rationale for performing incidental appendectomy in such patients includes the elimination of future appendicitis or diagnostic consideration of appendicitis, and the removal of undiagnosed incidental pathology involving the appendix.1 Identifying the morphological characteristics seen in appendiceal endometriosis increases the rationale for performing appendectomy during routine endoscopic excision of endometriosis. Consent to publish this image was obtained from the patient.