Original Article
Endometriosis of the Appendix: When to Predict and How to Manage—A Multivariate Analysis of 1935 Endometriosis Cases

https://doi.org/10.1016/j.jmig.2019.02.015Get rights and content

ABSTRACT

Study Objective

To evaluate appendiceal endometriosis (AE) prevalence and risk factors in endometriotic patients submitted to surgery.

Setting

A tertiary level referral center, university hospital.

Patients

One thousand nine hundred thirty-five consecutive patients who underwent surgical removal for symptomatic endometriosis.

Interventions

Electronic medical records of patients submitted to surgery over a 12-year period were reviewed. We assessed any correlation between demographic, clinical, and surgical variables and AE. In our center, appendectomy was performed using a selective approach. Appendix removal was performed in case of gross abnormalities of the organ, such as enlargement, dilation, tortuosity, or discoloration of the organ or the presence of suspected endometriotic implants.

Measurements and Main Results

AE prevalence was 2.6% (50/1935), with only 1 false-positive case at gross intraoperative evaluation. In multivariate analysis using a stepwise logistic regression model, independent risk factors for AE were adenomyosis (adjusted odds ratio [aOR] = 2.48; 95% confidence interval [CI], 1.32–4.68), right endometrioma (aOR = 8.03; 95% CI, 4.08–15.80), right endometrioma ≥5 cm (aOR = 13.90; 95% CI, 6.63–29.15), bladder endometriosis (aOR = 2.05; 95% CI, 1.05–3.99), deep posterior pelvic endometriosis (aOR = 5.79; 95% CI, 2.82–11.90), left deep lateral pelvic endometriosis (aOR = 2.11; 95% CI, 1.10–4.02), and ileocecal involvement (aOR = 12.51; 95% CI, 2.07–75.75).

Conclusion

Among patients with endometriosis submitted to surgery, AE was observed in 2.6%, and it was associated with adenomyosis, large right endometrioma, bladder endometriosis, deep posterior pelvic endometriosis, left deep lateral pelvic endometriosis, and ileocecal involvement.

Section snippets

Materials and Methods

We conducted a retrospective cohort study on the electronic medical records of consecutive patients who underwent surgical removal for symptomatic endometriosis at our referral center between August 2004 and October 2016. The only exclusion criterion was a history of appendectomy for other pathologies. One thousand nine hundred thirty-five women were included in the study.

Before surgery, an accurate medical history was collected, and all patients underwent bimanual and speculum examinations as

Results

Fifty-one patients underwent selective appendectomy for suspected AE. No patient was preoperatively diagnosed with AE. Pathological assessment confirmed AE in 50 of 51 samples (98%). The patient with a false diagnosis at macroscopic evaluation was found to have a fecalith. The prevalence of AE in our study population was 2.6% (50/1935). The study group presented chronic inflammatory and fibrotic features in 22 women (44%), whereas acute inflammatory reactions were found in 28 women (56%). There

What Is the Prevalence of AE?

In our study, AE prevalence among patients who underwent surgery for symptomatic endometriosis was 2.6%. Several authors had studied AE prevalence in women with endometriosis or other benign gynecologic and nongynecologic diseases (ie, myomas, pelvic mass, and etc.). Tables 3 and 4 provide a summary of our data compared with 32 relevant full-text articles on this topic. The following keywords were used to conduct a computerized search of PubMed/MEDLINE: “endometriosis” AND “appendix” OR

Conclusion

Among patients with endometriosis surgically treated, AE is observed in 2.6%, and it is associated with adenomyosis, large right endometrioma, bladder endometriosis, deep posterior pelvic endometriosis, left deep lateral pelvic endometriosis, and ileocecal involvement. It is mandatory to counsel the patient with endometriosis scheduled for surgery about the risk of appendix excision and to be surgically prepared to perform selective appendectomy, especially in the presence of these risk

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      Citation Excerpt :

      In this study, the incidence was 3.3% in the overall population, which is consistent with previous reports, considering that only a subgroup of fertile age women was analysed. When investigating the prevalence of endometriosis of the appendix among women already diagnosed with endometriosis, appendiceal endometriosis was found in 2.6% of cases, if selective appendectomy (in case of gross alterations of the appendix at intra-operative evaluation or pre-operative imaging) was performed during an operation for endometriosis (Mabrouk et al., 2020). Furthermore, the application of a very detailed histopathology protocol may increase the detection of appendiceal endometriosis from 7.7% to 12.3% (Ross et al., 2020).

    View all citing articles on Scopus

    The authors declare that they have no conflict of interest.

    Précis: Appendiceal endometriosis was observed in 2.6% of patients with endometriosis, especially in the presence of adenomyosis, large right endometrioma, deep pelvic lesions, and ileocecal involvement.

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