1688 Colonoscopic Resection of Appendiceal Endometriosis

INTRODUCTION: We present a 66-year-old lady who presented with a polypoid lesion found on screening colonoscopy in the appendiceal orifice. On repeat colonoscopy, a partially inverted appendix was seen. Possible carcinoid was in the differential diagnosis as well as a submucosal lesion. CASE DESCRIPTION/METHODS: Using a double channel colonoscopy, the appendicealorifice and the partially inverted appendix were identified. 10 mls of ORISE lifting gel was injected submucosally. Then, using a 2-snare technique. 1 snare was passed over the appendix. The second snare was passed over the distal partially inverted appendix. Then using traction, the appendix was completely inverted into the lumen of the cecum. Afterwards, the snare, which was over the appendix, cut, was closed and standard polypectomy technique was used to cut the appendix. The appendix was then captured with the snare that was used for traction with the other open channel . Clips were deployed to close the defect The gross pathology was sent which revealed an infiltrated appendix with endometrial tissue consistent with appendiceal endometriosis. CT scan follow up did not reveal any evidence of perforation. Patient was discharged within 24 hours from the hospital. DISCUSSION: Endometriosis (EM) is the presence of endometrial tissue outside the uterine cavity. Appendiceal EM is rare and comprises about 3% of all gastrointestinal EM with an incidence of less than 1%. It is usually found incidentally during appendectomies or during colonoscopies if the appendicealorifice is found to be inverted. Appendectomies are usually preformed laparoscopically, few cases have been reported of endoscopic resection of an appendix. We are reporting the first case of appendiceal EM that was resected endoscopically. Watch the video: http://bit.ly/2O2SEhu.