Appendiceal Endometriosis: A Rare Case of Endometriosis Mimicking Acute Appendicitis

Regent Lee, Riah S Lee, Yasmine Hemida, Douglas E. James, Douglas James
Cureus · 2025 · vol. 17(3) , pp. e81280 · doi:10.7759/cureus.81280 · PMID:40291266 · PMC12032854 · W4408890785
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 39-year-old female whose appendiceal endometriosis mimicked acute appendicitis, requiring laparoscopic appendectomy for diagnosis and management.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper reports a 39-year-old woman with acute right lower quadrant pain, intermittent non-bloody diarrhea, nausea, and vomiting that was clinically and on CT imaging interpreted as mild appendicitis. The authors performed a laparoscopic appendectomy, after which histopathology showed endometriosis in the appendix with acute and chronic hemorrhage, and immunohistochemistry supported endometrial-type glands (CK7 and ER positive; CK20 and CDX2 negative), while the appendix itself lacked classic acute appendicitis. The main limitation is that this is a single case, so the findings mainly illustrate diagnostic uncertainty rather than establishing a reliable preoperative diagnostic approach; the paper also notes that no specific preoperative test exists beyond histopathology confirmation. This paper is centrally about endometriosis — it is a case report of appendiceal endometriosis mimicking acute appendicitis and confirmed by histopathology.

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Abstract

Appendiceal endometriosis (AE) is a rare type of extragonadal endometriosis with symptoms of right lower abdominal pain, nausea, and vomiting that mimic acute appendicitis. The gold standard for a definitive diagnosis is a histopathological examination of the excised appendix. We report a case of AE in a 39-year-old female patient, G10P3, with a past surgical history of cholecystectomy, seven dilation and curettage procedures, and one prior cesarean section presenting with a right lower quadrant pain with intermittent non-bloody diarrhea, nausea, and vomiting that is not exacerbated by movement. The patient was mildly tachycardic with otherwise stable vitals and no leukocytosis. The beta-hCG test was negative with a CT-confirmed Mirena® intrauterine contraceptive device (IUD) (Bayer AG, Leverkusen, Germany) placement. The patient denied heavy bleeding or vaginal discharge. The CT scan of the abdomen and pelvis with oral contrast demonstrated findings suggestive of appendicitis, leading to a subsequent laparoscopic appendectomy. The resected specimen showed histopathology features of endometriosis, confirming AE. AE poses diagnostic challenges due to its nonspecific imaging findings along with variable symptomatic presentations. The recommended management of AE is an appendectomy with a gynecological follow-up postoperatively. AE is a rare condition that can masquerade as acute appendicitis in female patients. We highlight the importance of including AE in the differential diagnosis of female patients presenting with lower abdominal pain.

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Condition tags

endometriosis

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