Int J Colorectal Dis DOI 10.1007/s00384-014-1987-7
LETTER TO THE EDITOR
Chronic appendicitis secondary to endometriosis: a case report Yue Ming Huang & Chuang Qi Chen & Li Ding & Xiao Jiang Yi & Yu Long He
Accepted: 5 August 2014 # Springer-Verlag Berlin Heidelberg 2014
Dear Editor: Here is our case report of appendiceal endometriosis which presented manifestations of acute attack of chronic appendicitis and underwent an appendectomy.
Case report A 42-year-old woman presented to the emergency department of our hospital on September 12, 2013 with a complaint of persistent right lower quadrant abdominal pain for 3 days. Her manifestations included no fever, nausea, vomiting, or diarrhea, and she has a history of a 3-year-repeated dull abdominal pain about every 1 or 2 months. Her menses is regular for about 1 month, and her last menstrual period was on September 5, 2013. Physical examinations revealed obvious tenderness and rebound tenderness in the right lower quadrant of the abdomen, especially in the McBurney’s point, and Rovsing’s sign also showed as positive. About the laboratory tests, the white blood cell count and percentage of neutrophils were 10.03×109/L and 81.2 %, respectively. Meanwhile, pregnancy test was negative. Before in-hospital, the appendiceal radiography showed a chronic appendicitis sign. With a preoperative diagnosis of acute attack of chronic appendicitis, a laparotomy was performed. During exploration, the appendix, which was 6 cm in length, was in inferior of the cecum and the distal part appeared hyperemic and edematous. No abscess Y. M. Huang (*) : C. Q. Chen : X. J. Yi : Y. L. He Department of Gastrointestinal Surgery and Colorectal Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58, ZhongShan Road II, Yuexiu, Guangzhou 510080, Guangdong, China e-mail: [email protected] L. Ding Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, 58, ZhongShan Road II, Yuexiu, Guangzhou 510080, Guangdong, China
was found in the abdominal cavity. Therefore, an appendectomy was performed. No complications occurred postoperatively and the patient was discharged after 3 days, and the patient did not complain of relative discomforts any more on follow-up. The subsequent histopathologic examination showed lymphocyte and plasmocyte infiltration in every layer of the appendix which revealed chronic appendicitis, and what is more, some luminal-like glands and stroma structures were found within the muscularis close to the serosa. Further immunohistochemical dye showed CD10 (+), CK7 (+), ER (+), PR (+), CK20 (−), and CR (−) of the luminal-like structures, which confirmed the diagnosis of appendiceal endometriosis.
Discussion Endometriosis (EMT) is defined as the growth of endometrial tissues, including the endometrial glands and stromas, outside the lining of uterine cavity. EMT is common in women during the reproductive age. It can cause periodic pelvic pain and even infertility in up to 50 % of these patients because endometriosis is most commonly located in the gynecologic organs, especially the ovaries, and pelvic peritoneum. In addition, endometriosis can also be found in the gastrointestinal tract and cause series of symptoms and signs, such as abdominal pain, melena, intestinal hemorrhage, intussusception, and perforation. Gastrointestinal endometriosis takes about 3– 37 % of all the cases, and appendiceal endometriosis accounts for only about 3 % of gastrointestinal endometriosis, which means
LETTER TO THE EDITOR
Chronic appendicitis secondary to endometriosis: a case report Yue Ming Huang & Chuang Qi Chen & Li Ding & Xiao Jiang Yi & Yu Long He
Accepted: 5 August 2014 # Springer-Verlag Berlin Heidelberg 2014
Dear Editor: Here is our case report of appendiceal endometriosis which presented manifestations of acute attack of chronic appendicitis and underwent an appendectomy.
Case report A 42-year-old woman presented to the emergency department of our hospital on September 12, 2013 with a complaint of persistent right lower quadrant abdominal pain for 3 days. Her manifestations included no fever, nausea, vomiting, or diarrhea, and she has a history of a 3-year-repeated dull abdominal pain about every 1 or 2 months. Her menses is regular for about 1 month, and her last menstrual period was on September 5, 2013. Physical examinations revealed obvious tenderness and rebound tenderness in the right lower quadrant of the abdomen, especially in the McBurney’s point, and Rovsing’s sign also showed as positive. About the laboratory tests, the white blood cell count and percentage of neutrophils were 10.03×109/L and 81.2 %, respectively. Meanwhile, pregnancy test was negative. Before in-hospital, the appendiceal radiography showed a chronic appendicitis sign. With a preoperative diagnosis of acute attack of chronic appendicitis, a laparotomy was performed. During exploration, the appendix, which was 6 cm in length, was in inferior of the cecum and the distal part appeared hyperemic and edematous. No abscess Y. M. Huang (*) : C. Q. Chen : X. J. Yi : Y. L. He Department of Gastrointestinal Surgery and Colorectal Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58, ZhongShan Road II, Yuexiu, Guangzhou 510080, Guangdong, China e-mail: [email protected] L. Ding Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, 58, ZhongShan Road II, Yuexiu, Guangzhou 510080, Guangdong, China
was found in the abdominal cavity. Therefore, an appendectomy was performed. No complications occurred postoperatively and the patient was discharged after 3 days, and the patient did not complain of relative discomforts any more on follow-up. The subsequent histopathologic examination showed lymphocyte and plasmocyte infiltration in every layer of the appendix which revealed chronic appendicitis, and what is more, some luminal-like glands and stroma structures were found within the muscularis close to the serosa. Further immunohistochemical dye showed CD10 (+), CK7 (+), ER (+), PR (+), CK20 (−), and CR (−) of the luminal-like structures, which confirmed the diagnosis of appendiceal endometriosis.
Discussion Endometriosis (EMT) is defined as the growth of endometrial tissues, including the endometrial glands and stromas, outside the lining of uterine cavity. EMT is common in women during the reproductive age. It can cause periodic pelvic pain and even infertility in up to 50 % of these patients because endometriosis is most commonly located in the gynecologic organs, especially the ovaries, and pelvic peritoneum. In addition, endometriosis can also be found in the gastrointestinal tract and cause series of symptoms and signs, such as abdominal pain, melena, intestinal hemorrhage, intussusception, and perforation. Gastrointestinal endometriosis takes about 3– 37 % of all the cases, and appendiceal endometriosis accounts for only about 3 % of gastrointestinal endometriosis, which means
