Ijaz Samia, Lidder Surjit, Mohamid Waria, Carter Martyn, Thompson Hilary
Department of General Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, UK.
J Med Case Rep. 2008 Jan 22;2:12. doi: 10.1186/1752-1947-2-12.
Intussusception of the appendix is an extremely rare condition that ranges from partial invagination of the appendix to involvement of the entire colon. Endometriosis is an exceptionally rare cause of appendiceal intussusception and only very few cases have been reported in the literature to date.
A 40 year-old woman presented to clinic with a long history of lower abdominal pain, loose motions and painful, heavy periods. Subsequent colonoscopy revealed submucosal endometriotic nodules in the sigmoid as well as a polyp thought to be arising from the appendix, which had inverted itself. She was referred to a colorectal surgeon because the polyp could not be removed endoscopically despite several attempts. At laparotomy, the appendix had intussuscepted but it was possible to reduce it and therefore a simple appendicectomy was carried out. On histology, there were widespread endometrial deposits within the wall of the appendix and this was thought to be the basis for the intussusception.
Histological evidence of the lead point is of crucial importance in cases of appendiceal intussusception, in order to exclude an underlying neoplastic process. Consequently, surgical resection is necessary either through an open or a laparoscopic approach. Gastrointestinal endometriosis should be considered as a cause of appendiceal intussusception in post-menarchal women with episodic symptoms and proven disease.
阑尾套叠是一种极为罕见的病症，范围从阑尾部分套入到整个结肠受累。子宫内膜异位症是阑尾套叠极为罕见的病因，迄今为止文献中仅报道了极少数病例。
一名40岁女性因长期下腹痛、腹泻及痛经、月经过多就诊。随后的结肠镜检查发现乙状结肠有黏膜下子宫内膜异位结节，还有一个据认为起源于阑尾的息肉，该息肉已发生套叠。尽管多次尝试，该息肉仍无法通过内镜切除，因此她被转诊给结直肠外科医生。剖腹手术时，阑尾已发生套叠，但可以将其复位，因此进行了单纯阑尾切除术。组织学检查显示阑尾壁内有广泛的子宫内膜沉积，这被认为是套叠的基础。
在阑尾套叠病例中，套叠起始点的组织学证据对于排除潜在的肿瘤性病变至关重要。因此，无论是通过开放手术还是腹腔镜手术进行切除都是必要的。对于有发作性症状且确诊患有疾病的初潮后女性，应考虑胃肠道子宫内膜异位症是阑尾套叠的病因。
