A Case Report of Endometriosis of the Appendix with Appendicoduodenal Fistula

Yoshihiro Nishida, Tomoaki Urakawa, Mitsuharu Nakamoto, Katsunori Kawaguchi, Tatsuo Sako, Takashi Kamigaki, Hiroshi Haranomura, Shirou Nakae, Sachio Nishio, Akio Ioroi, Kiyoshi Uematsu, Yukihiro Imai*

Department of Surgery, Kobe Rosai Hospital of the Labor Welfare Corporation
*First Department of Pathology, Kobe University School of Medicine

Endometriosis of the appendix has rarely been reported in Japan, as has spontaneous appendicoduodenal fistula. This is a case report of endometriosis of the appendix accompanied by a fistula of the duodenum. The patient, aged 68 years, was admitted to our department mainly for cancer of the ascending colon. From photographic examination we preoperatively diagnosed appendicoduodenal fistula, right ovarian cyst, and ascending colon cancer, and performed an operation. The appendix, rising along the mesenteric side of the ascending colon, flexed and fibrously adhered to the right lower part of the third portion of the duodenum, making a fistula. We detached the adhesion and closed the fistula by direct suturing. Pathohistologicaly we found a glandular structure in the subserosal layer of the appendix and the cilia at the inner side of it, but no interstitial component or bleeding focus. Our case was asymptomatic and endometriosis of the appendix, which was accompanied by right ovarian endometriosis, was accidentally detected by postoperative pathological study. Endometriosis of the appendix is likely to be accompanied by that of intrapelvic organs, so we must pay attention to endometriosis of other organs before and during surgery, and perform an adequate operation.

Key words
endometriosis of appendix, appendicoduodenal fistula

Reprint requests
Yoshihiro Nishida Department of Surgery, Kobe Rosai Hospital of the Labor Welfare Corporation
1-34-603, 3 Chome, Oyashiki-dori, Nagata-ku, Kobe, 653 JAPAN

Accepted
September 4, 1991

To read the PDF file you will need Abobe Reader installed on your computer.