What are other Names for this Condition? (Also known as/Synonyms)

• Appendiceal Endometriosis

What is Endometriosis of Appendix? (Definition/Background Information)

• Endometriosis of Appendix is a very rare condition in which the tissue of the endometrium occurs in the appendix (the small bag-like projection in the lower-right side of the large intestine). This condition is only seen in women
• The endometrium is the lining of the uterus that proliferates during the menstrual cycle and sheds during menstruation. This cyclical pattern is created by the response of glands and blood vessels present in the endometrium to fluctuating levels of estrogen and progesterone during the menstrual cycle
• Endometriosis is the presence of benign endometrial tissue in abnormal locations outside of the uterus in the pelvis and occasionally, the abdomen and elsewhere
• Appendiceal Endometriosis may be either asymptomatic or cause severe abdominal pain, fever, fatigue, and appetite loss. The condition can mimic acute appendicitis. If left untreated, it may lead to chronic pain affecting one’s normal quality of life. The appendix is also at risk for perforation, in some rare cases
• The symptoms of Appendiceal Endometriosis can be managed through pain medications and oral contraceptives. However, in many cases, a surgical excision and removal of the appendix, can help in treating the condition adequately. The prognosis is generally good with appropriate treatment (surgery)

Who gets Endometriosis of Appendix? (Age and Sex Distribution)

• According to studies, Endometriosis of Appendix normally affects women of child-bearing age; most women are in the age range of 16-44 years, at the time of diagnosis
• The condition is observed worldwide and all racial and ethnic groups are generally at risk
• It is reported that only 3% of endometriosis of the gastrointestinal tract constitute Appendiceal Endometriosis

What are the Risk Factors for Endometriosis of Appendix? (Predisposing Factors)

The risk factors of Endometriosis of Appendix may include the following:

• Presence of endometriosis of other organs in the body
• A family history of endometriosis
• Anatomic malformations blocking the reproductive outflow tract
• First menstrual cycle at an early age
• Frequent menstrual cycles or periods lasting greater than 7 days
• No prior pregnancy
• Exposure to diethylstilbestrol in utero (mother receiving the drug when pregnant)
• Exposure to dioxin and dioxin-like compounds found in industrial waste
• Low birth weight (of the woman)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Endometriosis of Appendix? (Etiology)

The exact cause of extrauterine (outside the uterus) endometrial lesions is unknown.

• Endometriosis of Appendix may occur due to abnormally-placed endometrial tissue in the appendix
• Another theory involves the spread of endometrial cells through blood vessels or lymphatics to other pelvic structures

What are the Signs and Symptoms of Endometriosis of Appendix?

Some patients of Endometriosis of Appendix are asymptomatic. The signs and symptoms may resemble those of acute and chronic appendicitis (a condition causing inflammation of the appendix) and it may include:

• Abdominal pain (in some, it may be associated with menstrual cycle); the pain may be cyclical in nature and related to menstrual cycle
• Sometimes, the pain can occur anywhere in the upper or lower abdomen, back, or rectum. It may be followed by nausea and vomiting
• Presence of swollen appendix
• Fever, shivering, chills
• Loss of appetite
• Constipation or diarrhea
• Symptoms of chronic pelvic pain may be observed

If Endometriosis of Appendix is asymptomatic, then it is often diagnosed incidentally, or on examination of appendix that is removed for other reasons.

How is Endometriosis of Appendix Diagnosed?

The diagnosis of Endometriosis of Appendix is undertaken using the following tools:

• Physical examination with detailed medical history: A pelvic examination and palpation of pelvic organs can suggest a diagnosis of endometriosis; in such cases, the treatment may be started without any additional tests being performed
• Laboratory tests, such as a complete blood count (CBC) and basic metabolic panel 
• X-ray of abdomen
• Ultrasound or CT scan of abdomen
• Exam of appendix during laparoscopy or parotomy, with biopsy of the suspected area. Sometimes, the entire appendix is removed (appendectomy)

Note: 

• The symptoms of Appendiceal Endometriosis may be similar to those seen in other conditions, such as pelvic inflammatory disease and acute appendicitis. Hence, other causes of pelvic pain and infertility must be ruled out (through a differential diagnosis)
• It is also important to exclude pregnancy, since ectopic pregnancies present similar symptoms and can lead to a misdiagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Endometriosis of Appendix?

The following complications of Endometriosis of Appendix may be expected:

• Infertility is associated with endometriosis in a sizeable number of cases, since endometriosis can affect the ovaries, fallopian tubes, and other reproductive organs along with the appendix
• Severe and chronic lower abdominal pain and discomfort that can affect the quality of one’s life
• Rupture of the appendix, which may be a medical emergency
• Infections that arise in the post-surgical period

How is Endometriosis of Appendix Treated?

In many cases of Endometriosis of Appendix, a surgery may be recommended by the healthcare provider. A surgical removal of the appendix (called appendectomy) in uncomplicated appendicitis may be done either laparoscopically or by surgically opening the abdomen.

• Open appendectomy involves making a deep incision on the lower abdomen and removing the appendix from the surrounding abdominal organs
• In laparoscopic approach, a surgeon makes 3 or 4 small incisions for insertion of the camera and the laparoscopic instruments and the appendix is cut and removed
• If necessary, a hemicolectomy may be performed, in which a part of the ascending colon along-with the appendix is surgically removed

Additional treatment options of Endometriosis of Appendix may include:

• Pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs including acetaminophen, ibuprofen, and naproxen) may provide relief of mild symptoms
• Oral contraceptives may also provide pain relief, by interrupting the menstrual cycle

How can Endometriosis of Appendix be Prevented?

Currently, there are no known preventative measures for the development of Endometriosis of Appendix.

What is the Prognosis of Endometriosis of Appendix? (Outcomes/Resolutions)

The prognosis for endometriosis is usually excellent. Single focus of endometriosis can be cured through excision, while multiple foci of endometriosis may be difficult to cure. However, the symptoms can be usually managed through adequate treatment.

• In most women, the prognosis of Endometriosis of Appendix is good with adequate treatment (surgical removal of the appendix)
• Invasive procedures to remove the appendix and suitable medication therapy may help improve infertility in some women. Infertility occurs when endometriosis affects other reproductive organs

Additional and Relevant Useful Information for Endometriosis of Appendix:

• According to studies, endometriosis affects up to 22% of menstruating women; although many cases remain asymptomatic

The following article link will help you understand endometriosis:

http://www.dovemed.com/diseases-conditions/endometriosis/