- Email: [email protected]
Bowel endometriosis and mucocele of the appendix
Journal of Minimally Invasive Gynecology (2005) 12, 299-300
Images in endoscopy
Bowel endometriosis and mucocele of the appendix Mauricio Simoes Abrao, MD, Sergio Podgaec, MD, Filomena M. Carvalho, MD, Manoel Orlando Gonçalves, MD, João Antonio Dias Jr., MD, and Marcelo Averbach, MD From the Endometriosis Division, Obstetrics and Gynecology Department, Hospital das Clínicas, São Paulo University School of Medicine, Sao Paulo, Brazil (Drs. Abrao, Podgaec, Carvalho, and Dias); Fleury Laboratories 01333-910 São Paulo, Brazil (Dr. Gonçalves); and Hospital Sírio Libanês, 01308-050 São Paulo, Brazil (Dr. Averbach).
Figure 3
Microscopic aspect of mucocele in the appendix.
Figure 1 Transvaginal ultrasound showing a 2.0 ⫻ 0.7-cm solid hypoechoic nodule in the ileum infiltrating muscularis propria.
Figure 2
Macroscopic aspect of the surgical specimen.
1553-4650/$ -see front matter © 2005 AAGL. All rights reserved. doi:10.1016/j.jmig.2005.04.003
Figure 4 Microscopic aspect of endometriosis in the muscular wall of the appendix.
300
Journal of Minimally Invasive Gynecology, Vol 12, No 4, July/August 2005
A nulliparous 32-year-old woman with chronic pelvic pain and nonconclusive imaging examinations (Figure 1) was seen in our department. During laparoscopy, we observed a cystic dilatation of the appendix close to a hard nodule in the terminal portion of the ileum (Figure 2). Laparoscopic resection of a segment of the terminal ileum and the cecum was performed, and an ileum-ascendent anastomosis was done. Histologic examination confirmed endometriosis and mucocele (Figures 3 and 4). Endometriosis affects women in reproductive age in different sites of the pelvis including the bowel, but not often in the appendix. The incidence of appendiceal involvement ranges from 0.8% to 20%,1,2 but it is rarely symptomatic. Corresponding author: Mauricio Simoes Abrao, MD, Rua São Sebastião 550, CEP 04708-001, São Paulo, SP, Brazil. E-mail: [email protected] Submitted January 12, 2005. Accepted for publication February 1, 2005.
Mucocele of the appendix denotes an obstructive dilatation of the appendiceal lumen due to abnormal accumulation of mucus, which may be related to a variety of pathologic conditions, such as postinflammation, fecalith, carcinoid tumor, and endometriosis.3 Appendiceal mucocele due to endometriosis is extremely rare, and few documented cases of such condition have been recorded in the literature.
References 1. Uohara JK, Kobara TY. Endometriosis of the appendix: report of twelve cases and review of the literature. Am J Obstet Gynecol. 1975;121:423426. 2. Pittaway DE. Appendectomy in the surgical treatment of endometriosis. Obstet Gynecol. 1983;61:421-424. 3. Driman DK, Melega DE, Vilos GA, Plewes EA. Mucocele of the appendix secondary to endometriosis. Am J Clin Pathol. 2000;113:860864.
Images in endoscopy
Bowel endometriosis and mucocele of the appendix Mauricio Simoes Abrao, MD, Sergio Podgaec, MD, Filomena M. Carvalho, MD, Manoel Orlando Gonçalves, MD, João Antonio Dias Jr., MD, and Marcelo Averbach, MD From the Endometriosis Division, Obstetrics and Gynecology Department, Hospital das Clínicas, São Paulo University School of Medicine, Sao Paulo, Brazil (Drs. Abrao, Podgaec, Carvalho, and Dias); Fleury Laboratories 01333-910 São Paulo, Brazil (Dr. Gonçalves); and Hospital Sírio Libanês, 01308-050 São Paulo, Brazil (Dr. Averbach).
Figure 3
Microscopic aspect of mucocele in the appendix.
Figure 1 Transvaginal ultrasound showing a 2.0 ⫻ 0.7-cm solid hypoechoic nodule in the ileum infiltrating muscularis propria.
Figure 2
Macroscopic aspect of the surgical specimen.
1553-4650/$ -see front matter © 2005 AAGL. All rights reserved. doi:10.1016/j.jmig.2005.04.003
Figure 4 Microscopic aspect of endometriosis in the muscular wall of the appendix.
300
Journal of Minimally Invasive Gynecology, Vol 12, No 4, July/August 2005
A nulliparous 32-year-old woman with chronic pelvic pain and nonconclusive imaging examinations (Figure 1) was seen in our department. During laparoscopy, we observed a cystic dilatation of the appendix close to a hard nodule in the terminal portion of the ileum (Figure 2). Laparoscopic resection of a segment of the terminal ileum and the cecum was performed, and an ileum-ascendent anastomosis was done. Histologic examination confirmed endometriosis and mucocele (Figures 3 and 4). Endometriosis affects women in reproductive age in different sites of the pelvis including the bowel, but not often in the appendix. The incidence of appendiceal involvement ranges from 0.8% to 20%,1,2 but it is rarely symptomatic. Corresponding author: Mauricio Simoes Abrao, MD, Rua São Sebastião 550, CEP 04708-001, São Paulo, SP, Brazil. E-mail: [email protected] Submitted January 12, 2005. Accepted for publication February 1, 2005.
Mucocele of the appendix denotes an obstructive dilatation of the appendiceal lumen due to abnormal accumulation of mucus, which may be related to a variety of pathologic conditions, such as postinflammation, fecalith, carcinoid tumor, and endometriosis.3 Appendiceal mucocele due to endometriosis is extremely rare, and few documented cases of such condition have been recorded in the literature.
References 1. Uohara JK, Kobara TY. Endometriosis of the appendix: report of twelve cases and review of the literature. Am J Obstet Gynecol. 1975;121:423426. 2. Pittaway DE. Appendectomy in the surgical treatment of endometriosis. Obstet Gynecol. 1983;61:421-424. 3. Driman DK, Melega DE, Vilos GA, Plewes EA. Mucocele of the appendix secondary to endometriosis. Am J Clin Pathol. 2000;113:860864.