A Case of Intestinal Obstruction and Acute Appendicitis Caused by Endometoriosis of the Appendix and Ileum

Mikihiko Harada and Masaki O-hara

Department of Surgery, Hikari Municipal Yamato General Hospital

We report a case of endometriosis of the appendix and ileum with intestinal obstruction and acute appendicitis. A 42-year-old woman seen for right lower abdominal pain and vomiting was found in the physical examination to have tenderness and rebound tenderness in the right lower abdomen. Abdominal X-ray showed an intestinal obstruction. In emergency surgery based on a preoperation diagnosis of ileus with acute appendicitis, we found that the appendix had adhered to the ileomesenterium. After adhesiolysis, we observed wall thickening and some bleeding of the ileum and intussusception of the appendix into the cecum about 2 cm in diameter. We then resected the appendix. Endometriosis tissue found in the submucosa and muscle layer of the appendix yielded a pathological diagnosis of endometriosis of the appendix. Postoperative hormone therapy was not effective, and the patient suffered abdominal pain and appetite loss. Magnetic resonance imaging showed left ovarian cyst suggesting endometriosis. We conducted ileocecal resection, total hysterectomy, and bilateral salpingoophorectomy 2 months after the first surgery. Pathological examination showed endometriosis affecting the uterus, bilateral ovary, and ileum. The patient has shown no recurrence in the 3 years and 9 months since her last surgery.

Key words
intestinal obstruction, ileal endometriosis, appendiceal endometriosis

Reprint requests
Mikihiko Harada Department of Surgery, Hikari Municipal Yamato General Hospital
974 Iwata, Hikari, 743-0192 JAPAN

Accepted
February 28, 2007

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