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Intussusception of the appendix secondary to endometriosis: a case report.

Ijaz S, Lidder S, Mohamid W, Carter M, Thompson H - J Med Case Rep (2008)

Bottom Line: A 40 year-old woman presented to clinic with a long history of lower abdominal pain, loose motions and painful, heavy periods.At laparotomy, the appendix had intussuscepted but it was possible to reduce it and therefore a simple appendicectomy was carried out.Consequently, surgical resection is necessary either through an open or a laparoscopic approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, UK. samiaijaz@hotmail.com

ABSTRACT

Introduction: Intussusception of the appendix is an extremely rare condition that ranges from partial invagination of the appendix to involvement of the entire colon. Endometriosis is an exceptionally rare cause of appendiceal intussusception and only very few cases have been reported in the literature to date.

Case presentation: A 40 year-old woman presented to clinic with a long history of lower abdominal pain, loose motions and painful, heavy periods. Subsequent colonoscopy revealed submucosal endometriotic nodules in the sigmoid as well as a polyp thought to be arising from the appendix, which had inverted itself. She was referred to a colorectal surgeon because the polyp could not be removed endoscopically despite several attempts. At laparotomy, the appendix had intussuscepted but it was possible to reduce it and therefore a simple appendicectomy was carried out. On histology, there were widespread endometrial deposits within the wall of the appendix and this was thought to be the basis for the intussusception.

Conclusion: Histological evidence of the lead point is of crucial importance in cases of appendiceal intussusception, in order to exclude an underlying neoplastic process. Consequently, surgical resection is necessary either through an open or a laparoscopic approach. Gastrointestinal endometriosis should be considered as a cause of appendiceal intussusception in post-menarchal women with episodic symptoms and proven disease.

No MeSH data available.


Related in: MedlinePlus

Colonoscopy view of suspected caecal polyp.
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Figure 1: Colonoscopy view of suspected caecal polyp.

Mentions: A 40-year-old woman presented to gastroenterology outpatients clinic with a several month history of right iliac fossa pain and loose motions. Apart from longstanding dysmenorrhoea and menorrhagia, she did not have any other symptoms. There was no past medical history to note and no family history of endometriosis. A clinical examination of the patient, including a full gynaecological examination, was within normal limits. Preliminary investigations revealed an iron deficiency anaemia with a haemoglobin level of 11.1 g/dl, a mean corpuscular volume of 71 fl and a low ferritin level of 8.4 ng/ml. A colonoscopy was duly organised which showed a sessile 1 cm polyp in the caecum [see figure 1]. On biopsy, this proved to be a metaplastic polyp. A subsequent attempted polypectomy was unsuccessful so the patient was referred to a tertiary centre where another attempt at polypectomy was carried out. At this point, the polyp looked to be arising from the appendix, which itself was inverted. In addition, submucosal nodules in the sigmoid were noted and these were thought to be endometrial in origin as the patient had a long history of painful and heavy periods. The polyp was not removed and the patient was referred to the colorectal surgeons and gynaecologists for a possible right hemicolectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy.


Intussusception of the appendix secondary to endometriosis: a case report.

Ijaz S, Lidder S, Mohamid W, Carter M, Thompson H - J Med Case Rep (2008)

Colonoscopy view of suspected caecal polyp.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2254640&req=5

Figure 1: Colonoscopy view of suspected caecal polyp.
Mentions: A 40-year-old woman presented to gastroenterology outpatients clinic with a several month history of right iliac fossa pain and loose motions. Apart from longstanding dysmenorrhoea and menorrhagia, she did not have any other symptoms. There was no past medical history to note and no family history of endometriosis. A clinical examination of the patient, including a full gynaecological examination, was within normal limits. Preliminary investigations revealed an iron deficiency anaemia with a haemoglobin level of 11.1 g/dl, a mean corpuscular volume of 71 fl and a low ferritin level of 8.4 ng/ml. A colonoscopy was duly organised which showed a sessile 1 cm polyp in the caecum [see figure 1]. On biopsy, this proved to be a metaplastic polyp. A subsequent attempted polypectomy was unsuccessful so the patient was referred to a tertiary centre where another attempt at polypectomy was carried out. At this point, the polyp looked to be arising from the appendix, which itself was inverted. In addition, submucosal nodules in the sigmoid were noted and these were thought to be endometrial in origin as the patient had a long history of painful and heavy periods. The polyp was not removed and the patient was referred to the colorectal surgeons and gynaecologists for a possible right hemicolectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Bottom Line: A 40 year-old woman presented to clinic with a long history of lower abdominal pain, loose motions and painful, heavy periods.At laparotomy, the appendix had intussuscepted but it was possible to reduce it and therefore a simple appendicectomy was carried out.Consequently, surgical resection is necessary either through an open or a laparoscopic approach.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, UK. samiaijaz@hotmail.com

ABSTRACT

Introduction: Intussusception of the appendix is an extremely rare condition that ranges from partial invagination of the appendix to involvement of the entire colon. Endometriosis is an exceptionally rare cause of appendiceal intussusception and only very few cases have been reported in the literature to date.

Case presentation: A 40 year-old woman presented to clinic with a long history of lower abdominal pain, loose motions and painful, heavy periods. Subsequent colonoscopy revealed submucosal endometriotic nodules in the sigmoid as well as a polyp thought to be arising from the appendix, which had inverted itself. She was referred to a colorectal surgeon because the polyp could not be removed endoscopically despite several attempts. At laparotomy, the appendix had intussuscepted but it was possible to reduce it and therefore a simple appendicectomy was carried out. On histology, there were widespread endometrial deposits within the wall of the appendix and this was thought to be the basis for the intussusception.

Conclusion: Histological evidence of the lead point is of crucial importance in cases of appendiceal intussusception, in order to exclude an underlying neoplastic process. Consequently, surgical resection is necessary either through an open or a laparoscopic approach. Gastrointestinal endometriosis should be considered as a cause of appendiceal intussusception in post-menarchal women with episodic symptoms and proven disease.

No MeSH data available.


Related in: MedlinePlus