Endometriosis and the appendix: a case series and comprehensive review of the literature.
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.
Gustofson
Robert L
RL
Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
Kim
Nancy
N
Liu
Shannon
S
Stratton
Pamela
P
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