Tuba ovarian abscesses formation from decidualized ovarian endometrioma\nafter appendiceal endometriosis presenting as acute appendicitis in\npregnancy

Background: Acute appendicitis with appendicial endometriosis is a very\ninfrequently encountered condition during pregnancy. Decidualization is\nthe hypertrophy of endometrial stromal cells by the effect of\nprogesterone. Similarly, in pregnancy, ectopic stromal endometrial\ncells in endometriosis can also be transformed by the same mechanism\nand ectopic decidua (deciduosis) may occur. Case: Here we report a 30\nyear old pregnant woman presenting twice with acute abdominal symptoms\nrequiring surgery for appendicial and ovarian endometriosis and\ndeciduosis. We emphasize that deciudualized endometriosis may first\npresent during pregnancy with acute abdomen necessitating emergency\nlaparotomy and complicating the course of gestation. Conclusion: To our\nknowledge only 9 cases in which decidualized endometriotic tissue\ncausing acute abdomen necessitating surgery during pregnancy were\nreported in the literature. What makes our case special is that the\npatient needed two laparotomies during the pregnancy period which was a\nvery stressful situation for both the patient and the physicians.