• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

CASE REPORT: AN UNUSUAL CASE OF ACUTE APPENDICITIS – CECAL ENDOMETRIOSIS

Romina Deldar, MD1, Chaitanya Vadlamudi, MD1, Gao L Chen, MD2. 1Georgetown University Hospital, 2Kaiser Permanente, Mid-Atlantic States

INTRODUCTION: Acute appendicitis can arise from many etiologies. We present a case of acute appendicitis that was radiographically suspicious for appendiceal mucocele. However, final pathology revealed luminal obstruction secondary to cecal endometriosis. Cecal endometriosis is exceedingly rare, and only a few case reports describe this as a cause of appendicitis.

METHODS AND PROCEDURE: A healthy 33-year-old woman with no prior gynecologic history presented on day five of her menstrual cycle with 48-hours of right lower quadrant abdominal pain, nausea, emesis, and leukocytosis of 13,900/mm3. Computed tomography (CT) of the abdomen revealed a 10-centimeter, distended and fluid-filled appendix, suspicious for mucocele (Figure 1). As clinical and radiographic evidence was consistent with acute appendicitis, the patient was taken for laparoscopic appendectomy. Intraoperatively, the appendix was noted to be massively dilated and associated with a firm cecal mass just beyond the appendiceal base. These findings raised suspicion for appendiceal mucinous neoplasm, therefore the operation was converted to open. A partial cecectomy was performed in addition to appendectomy. The appendix, cecal base, and mesoappendix were removed en bloc with no spillage. No mucinous deposits or other abnormalities were identified. The patient tolerated the procedure well and was discharged home on post-operative day one.

Figure 1. CT axial view showing dilated fluid-filled appendix.

RESULTS: Three independent pathologists reviewed the specimens and found no evidence of an appendiceal mucinous neoplasm. Fluid within the appendiceal lumen did not stain positive for mucin. The specimen was consistent with acute appendicitis without evidence of malignancy. Interestingly, the cecum at the appendiceal base was noted to contain endometrial glands with surrounding stromal tissue in the muscularis propria, consistent with endometriosis (Figure 2). During menses, increased inflammation and tissue edema of the endometrial tissue positioned at the appendiceal base may have led to luminal obstruction and subsequent acute appendicitis. The patient had no other symptoms of endometriosis.

Figure 2. Focus of endometriosis in the muscularis propria (MP) of the cecum. Endometrial gland (E) and surrounding stromal tissue (S). Hematoxylin and eosin stain, 100x.

CONCLUSION: Cystic dilatation of the appendix can result from luminal obstruction secondary to a wide spectrum of benign or neoplastic causes. Clinically suspicious appendiceal mucocele should be resected intact to prevent mucinous deposits from seeding the abdomen and causing pseudomyxoma peritonei. Pathologic examination can reveal an unexpected diagnosis. This case simultaneously highlights an unusual presentation of endometriosis and an extraordinarily rare etiology of acute appendicitis.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 92294

Program Number: P019

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

View this Poster

302

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2019 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons