Appendiceal disease in women with endometriosis and right lower quadrant pain.
OBJECTIVE
To evaluate the frequency and range of appendiceal disease in women with endometriosis and right lower quadrant (RLQ) pain, and to estimate the value of preoperative gastrograffin enema (GGE) as a screen for the disease.


METHODS
Nonrandomized clinical trial (Canadian Task Force classification II-2).


METHODS
University-affiliated hospital with a private practice setting.


METHODS
A subpopulation of 65 women from a group of 337 patients undergoing laparoscopy for symptomatic endometriosis.


METHODS
Preoperative GGE was performed whenever possible in these women. At laparoscopy, the appendix was removed if it appeared abnormal or if the preoperative GGE was positive.


RESULTS
Of 65 women (19%) with symptomatic endometriosis and preoperative RLQ pain, 52 (80%) underwent appendectomy as part of surgery. Of these 52 excised appendixes, 39 (75%) had histologically confirmed pathology including appendicitis or periappendicitis, endometriosis, fibrous obliteration, lymphoid hyperplasia, and carcinoid tumor. Preoperative GGE had sensitivity of 74% and specificity of 83% for appendiceal disease. Its positive predictive value was 95% and negative predictive value was 42%. No complications from laparoscopic appendectomy occurred.


CONCLUSIONS
Disease of the appendix is common in women with endometriosis and RLQ pain. Appendectomy is particularly likely if preoperative GGE is positive.
Harris
R S
RS
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 160W, Los Angeles, CA 90048, USA.
Foster
W G
WG
Surrey
M W
MW
Agarwal
S K
SK
D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D001707:Biopsy, Needle; D015331:Cohort Studies; D015897:Comorbidity; D003974:Diatrizoate Meglumine; D004715:Endometriosis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D004733:Enema; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D016343:Monitoring, Intraoperative; D011300:Preoperative Care; D018570:Risk Assessment
D003974:Diatrizoate Meglumine