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

- 期刊 子宮內膜異位引致闌尾套疊，是一非常罕見的臨床現象。我們報告一位45歲女性病人，已有20年子宮內膜異位的病史，最近三年有間歇性肚臍周圍及下腹部絞痛。近二個月有持續疼痛的情形，且合併腹瀉及裹急後重。全大腸鏡檢發現在盲腸的闌尾開口處有一雪茹狀類息肉樣的腫塊。開刀時在迴盲瓣旁可摸到盲腸內有一硬塊且無法找到闌尾。由於巨觀上無法排除惡性腫瘤的可能且此腫瘤接近迴盲瓣，因此切除腫瘤並施行端對端迴腸大腸吻合術。打開盲腸即發現套疊的闌尾。在組織病理學檢查顯示，套疊的闌尾在漿膜下層及固有肌肉層可以發現有子宮內膜的腺体及基質的浸潤，手術後病情穩定且症狀緩解。回顧文獻，並討論有關闌尾套疊的症狀、病因、分類、診斷特徵及治療。 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.