Invagination of the Vermiform Appendix Due to Endometriosis: Report of a Case

Invagination of the vermiform appendix due to endometriosis is a very uncommon clinical phenomenon. We describe a 45-year-old woman with a 20-year history of endometriosis presenting with a 3-year history of intermittent cramping periumbilical and lower abdominal pain. The pain had become constant in the last two months and was associated with diarrhea and tenesmus. Colonoscopy revealed a cigar-shaped polypoid mass protruding from the appendiceal orifice within the cecum. At laparotomy, a hard intracecal mass was palpated adjacent to the ileocecal valve. The appendix could not be located. Since the possibility of a malignancy can not be excluded, the mass was resected, and an end-to-end ileocolic anastomosis was performed due to the proximity of the mass to the ileocecal valve. Upon opening the cecum, the invaginated appendix was recognized. The histopathological examination of the invaginated appendix demonstrated a picture of endometriosis with endometrial glands and stroma embedded in the subserosa and the muscularis propria. The postoperative course was uneventful. In this report, the symptoms, etiologic factors, classfication, diagnostic features, and treatment of invagination of the vermiform appendix are discussed, and the pertinent literature reviewed.