A Case of Appendicitis with Endometriosis of the Appendix Developing During Pregnancy

Yuhei Oshima, Noriaki Otagiri, Koutaro Sasahara
In: Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) · 2022 · vol. 47(6) , pp. 744–749 · doi:10.4030/jjcs.47.744 · W4390441171
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This case report describes a 33-year-old pregnant woman at 11 weeks gestation who presented with abdominal pain and was initially managed conservatively for suspected appendicitis. Symptoms recurred at 14 weeks, prompting emergency surgery after imaging revealed inflammatory markers and a right-sided pelvic mass, leading to an appendectomy under spinal anesthesia. Histopathological examination of the resected appendix confirmed extensive endometriosis in the appendiceal body, characterized by decidual changes likely induced by pregnancy. This paper is centrally about endometriosis — specifically, it documents a rare instance of appendiceal endometriosis that precipitated acute appendicitis during pregnancy.

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Abstract

症例は33歳，女性．妊娠11週３日．腹痛を主訴に当院を受診し，精査の結果虫垂炎と診断された．器官形成期であったため，手術療法は避け，保存的治療を行った．一旦軽快するも，妊娠14週４日に症状が再燃し，当院を受診した．血液検査では白血球数 11,700/mm３ CRP 1.14mg/dlと炎症反応の上昇を認めた．腹部MRI検査で，子宮右側に内腔が拡散強調像で高信号の多房性腫瘤を認め，腹部造影CT検査では子宮右腹側に境界不明瞭な腫瘤を認めた．右卵巣には炎症所見を認めなかったことから，急性虫垂炎と診断し，緊急手術を施行した．手術は脊椎麻酔で行い，傍腹直筋切開で虫垂切除術を行った．術後経過は良好で，術後５日目に退院となった．切除標本の病理所見では，虫垂体部の広範囲に子宮内膜症組織を認めた．内膜症組織では，妊娠に関連して起こったと思われる間質細胞の脱落膜変化を認めた．今回われわれは，妊娠を契機に虫垂炎を誘発した，虫垂子宮内膜症の１例を経験した．妊娠を契機に虫垂炎を発症した虫垂子宮内膜症の報告は非常に少なく，今後さらなる症例の蓄積が望まれる．
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症例報告 妊娠を契機に虫垂炎を発症した，虫垂炎子宮内膜症の１例 2022 年 47 巻 6 号 p. 744-749 詳細 抄録 症例は33歳，女性．妊娠11週３日．腹痛を主訴に当院を受診し，精査の結果虫垂炎と診断された．器官形成期であったため，手術療法は避け，保存的治療を行った．一旦軽快するも，妊娠14週４日に症状が再燃し，当院を受診した．血液検査では白血球数 11,700/mm３ CRP 1.14mg/dlと炎症反応の上昇を認めた．腹部MRI検査で，子宮右側に内腔が拡散強調像で高信号の多房性腫瘤を認め，腹部造影CT検査では子宮右腹側に境界不明瞭な腫瘤を認めた．右卵巣には炎症所見を認めなかったことから，急性虫垂炎と診断し，緊急手術を施行した．手術は脊椎麻酔で行い，傍腹直筋切開で虫垂切除術を行った．術後経過は良好で，術後５日目に退院となった．切除標本の病理所見では，虫垂体部の広範囲に子宮内膜症組織を認めた．内膜症組織では，妊娠に関連して起こったと思われる間質細胞の脱落膜変化を認めた．今回われわれは，妊娠を契機に虫垂炎を誘発した，虫垂子宮内膜症の１例を経験した．妊娠を契機に虫垂炎を発症した虫垂子宮内膜症の報告は非常に少なく，今後さらなる症例の蓄積が望まれる． © 2022 日本外科系連合学会

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