A Case of Endometriosis of the Appendix With Adhesion to Right Ovarian Cyst Presenting as Intussusception of a Mucocele of the Appendix

Akagi T, Tomonori Akagi, Seiichiro Yamamoto, Yamamoto S, Yutaka Kobayashi, Kobayashi Y, Fujita S, Shin Fujita, Takayuki Akasu, Akasu T, Moriya Y, Yoshihiro Moriya, Kato T, Tomoyasu Kato
Surgical laparoscopy, endoscopy & percutaneous techniques · 2008 · vol. 18(6) , pp. 622–625 · doi:10.1097/sle.0b013e318180f67f · PMID:19098675 · W2070676959
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This case report details a 35-year-old woman with appendiceal endometriosis causing intussusception of a mucocele, presenting as an ovarian cyst.

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This case report describes a 35-year-old woman presenting with intussusception-like changes and a mucocele of the appendix, initially complicated by difficulty differentiating the condition from a right ovarian cyst on imaging. Laparoscopic surgery revealed blueberry spots in the Douglas cul-de-sac and an atrophied appendix tightly adhered to the ovary, leading to appendectomy and partial cecectomy. Pathological examination confirmed that endometriosis-induced thickening and fibrosis of the appendiceal muscle layer caused the intussusception-like presentation. This paper is centrally about endometriosis — specifically, it details a rare manifestation of appendiceal endometriosis causing bowel obstruction and adhesion to an ovarian cyst.

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Abstract

Endometriosis of the appendix is rare, and we present a case of endometriosis of the appendix with adhesion to right ovarian cyst presenting as intussusception of a mucocele of the appendix in a 35-year-old woman with no associated sign of endometriosis. Colonoscopy revealed intussusception-like change and mucosal defect in the mucosa at the orifice of the appendix. Abdominal computed tomography showed a low-density lesion, which seemed to be right ovarian cyst. However, as the appendix was located near this site, differentiation between ovarian cyst and mucocele of the appendix was difficult. Laparoscopic examination disclosed blue berry spots on the Douglas cul-de-sac and right ovarian cyst, and the appendix was atrophied and hardened and tightly adhered to the right ovary. Laparoscopic appendectomy and partial cecectomy was performed, and on pathologic examination, thickening and fibrosis of the muscle layer owing to endometriosis were judged to have caused intussusception-like changes.
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A Case of Endometriosis of the Appendix With Adhesion to Right Ovarian Cyst Presenting as Intussusception of a Mucocele of the Appendix - Tomonori Akagi - Seiichiro Yamamoto - Yutaka Kobayashi - Shin Fujita - Takayuki Akasu - Yoshihiro Moriya - Tomoyasu Kato Endometriosis of the appendix is rare, and we present a case of endometriosis of the appendix with adhesion to right ovarian cyst presenting as intussusception of a mucocele of the appendix in a 35-year-old woman with no associated sign of endometriosis. Colonoscopy revealed intussusception-like change and mucosal defect in the mucosa at the orifice of the appendix. Abdominal computed tomography showed a low-density lesion, which seemed to be right ovarian cyst. However, as the appendix was located near this site, differentiation between ovarian cyst and mucocele of the appendix was difficult. Laparoscopic examination disclosed blue berry spots on the Douglas cul-de-sac and right ovarian cyst, and the appendix was atrophied and hardened and tightly adhered to the right ovary. Laparoscopic appendectomy and partial cecectomy was performed, and on pathologic examination, thickening and fibrosis of the muscle layer owing to endometriosis were judged to have caused intussusception-like changes.

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Condition tags

endometriosis

MeSH descriptors

Appendix Endometriosis Ovarian Cysts Ovarian Cysts Tissue Adhesions Adult Appendectomy Appendectomy Appendix Appendix Cecum Cecum Colonoscopy Diagnosis, Differential Endometriosis Endometriosis Endometriosis Female Humans Intussusception

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