title: Endometriosis and the appendix: a case series and comprehensive review of the literature.
abstract: OBJECTIVE
  To report the prevalence of appendiceal disease in women with chronic pelvic pain undergoing laparoscopy for possible endometriosis, summarize the literature, and more accurately estimate the prevalence of endometriosis of the appendix.
  
  
  METHODS
  Prospective case series and literature review.
  
  
  METHODS
  Academic research institute.
  
  
  METHODS
  One hundred thirty-three patients with chronic pelvic pain and possible endometriosis undergoing laparoscopy.
  
  
  METHODS
  History, physical exam, and abdominopelvic laparoscopy. Endometriosis and adhesions were excised using selective Nd:YAG contact laser trabeculoplasty and pathologically evaluated. Only patients with visible abnormalities involving the appendix were treated via concurrent laparoscopic appendectomy.
  
  
  METHODS
  Appendiceal abnormalities at laparoscopy.
  
  
  RESULTS
  Of 133 patients, 13 had a previous appendectomy with unknown pathology. Of the remaining 120 patients, 109 reported right lower quadrant pain. Of this subgroup, six patients had appendiceal pathology: four with pathology-confirmed endometriosis, one with Crohn's disease suspected at laparoscopy, and one with chronic appendicitis. The prevalence of appendiceal endometriosis in patients with biopsy-proven endometriosis (n = 97) or with right lower quadrant pain (n = 109) was 4.1% and 3.7%, respectively. This rate was similar to the 2.8% prevalence confirmed by literature review in patients with endometriosis but was much higher than that reported in all patients (0.4%).
  
  
  CONCLUSIONS
  Appendiceal endometriosis, while relatively uncommon in patients with endometriosis, is rare in the general population. In patients with right lower quadrant or pelvic pain, the appendix should be inspected for endometriosis and evidence of nongynecologic disease.
authors.affiliation: Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Gustofson
authors.forename: Nancy
authors.initials: N
authors.lastname: Kim
authors.forename: Shannon
authors.initials: S
authors.lastname: Liu
authors.forename: Pamela
authors.initials: P
authors.lastname: Stratton
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000150:complications; D001065:Appendix; D002429:Cecal Diseases / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D002908:Chronic Disease; D003424:Crohn Disease / Q000150:complications; D004715:Endometriosis / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008499:Medical Records; D008875:Middle Aged; D017699:Pelvic Pain / Q000150:complications*; D015995:Prevalence; D011446:Prospective Studies