Appendiceal endometriosis: an uncommon manifestation of deep infiltrating endometriosis

Appendiceal endometriosis is a rare cause of acute appendicitis, accounting for approximately 1% of cases.This report describes a case of a female patient presenting with right iliac fossa pain and clinical signs of acute abdomen, who underwent emergency appendectomy. Histopathological analysis confirmed acute appendicitis secondary to endometriosis, establishing a direct pathological link. Subsequent imaging with transvaginal ultrasonography (TVUS) and MRI revealed multifocal deep infiltrating endometriosis (DIE) involving the rectosigmoid junction, retrocervical region and rectovaginal septum. Based on these findings, the patient underwent a second surgical intervention, which included rectovaginal shaving. Intestinal endometriosis, a common manifestation of DIE, affects adjacent pelvic structures in up to 93% of cases. TVUS and MRI are essential tools for diagnosis and preoperative planning. While surgical treatment improves quality of life, access to timely, multidisciplinary care remains a major challenge in resource-limited settings.