Klein Sarah, Tourangeau-Young RaeAnn, Biglione Alejandro
Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Internal Medicine, Wellington Regional Medical Center, Wellington, USA.
Cureus. 2023 Apr 19;15(4):e37825. doi: 10.7759/cureus.37825. eCollection 2023 Apr.
The origin of endometriosis has multiple theories, with controversy over which may demonstrate the prominent pathophysiology. The most common extra-pelvic organ system affected by endometriosis is the gastrointestinal tract. Gastrointestinal endometriosis (GE) accounts for 3 to 37% of all endometriosis cases, and appendiceal endometriosis is present in around 3% of GE cases, therefore constituting less than 1% of all endometriosis cases. In this report, we present a 24-year-old female with a past medical history significant for endometriosis status post two excisional laparoscopies who presented with eight months' duration of right lower quadrant pain, constant and stabbing, with rebound tenderness. Appendectomy and histopathology demonstrated focal endometriosis, diffuse serosal fibrovascular adhesions involving the appendiceal serosa/subserosa, as well as a dilated lumen filled with hemorrhagic content. When the appendix is not considered in endometriosis pathology, patients are at increased risk for unresolved pain and further laparoscopic procedures. Prophylactic appendectomy appears to be a worthwhile consideration in patients with chronic pelvic pain, given the high frequency of appendiceal pathology.
子宫内膜异位症的起源有多种理论，关于哪种理论能体现其主要病理生理学存在争议。受子宫内膜异位症影响最常见的盆腔外器官系统是胃肠道。胃肠道子宫内膜异位症（GE）占所有子宫内膜异位症病例的3%至37%，阑尾子宫内膜异位症约占GE病例的3%，因此占所有子宫内膜异位症病例的比例不到1%。在本报告中，我们介绍了一名24岁女性，既往有子宫内膜异位症病史，接受过两次腹腔镜切除术，此次因右下象限疼痛持续8个月前来就诊，疼痛持续且呈刺痛，有反跳痛。阑尾切除术及组织病理学检查显示局灶性子宫内膜异位症、累及阑尾浆膜/浆膜下的弥漫性浆膜纤维血管粘连，以及充满血性内容物的扩张管腔。若在子宫内膜异位症病理检查中未考虑阑尾情况，患者出现疼痛未缓解及进一步行腹腔镜手术的风险会增加。鉴于阑尾病变的高发生率，对于慢性盆腔疼痛患者，预防性阑尾切除术似乎是一个值得考虑的选择。
