Endometriosis of the Appendix: Prevalence, Associated Lesions, and Proposal of Pathogenetic Hypotheses. A Retrospective Cohort Study with Prospectively Collected Data

Overview

Journal Arch Gynecol Obstet

Specialty Gynecology & Obstetrics

Date 2024 Aug 14

PMID 39143333

Authors

Gabriele Centini

Alessandro Ginetti

Irene Colombi

Alberto Cannoni

Matteo Giorgi

Helder Ferreira

Francesco Fedele

Martina Pacifici

Francesco Giuseppe Martire

Errico Zupi

Lucia Lazzeri

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the prevalence of endometriosis of the appendix and the association with other pelvic localizations of the disease and to provide pathogenesis hypotheses.

Methods: Monocentric, observational, retrospective, cohort study. Patients undergoing laparoscopic endometriosis surgery in our tertiary referral center were consecutively enrolled. The prevalence of the different localizations of pelvic endometriosis including appendix involvement detected during surgery was collected. Included patients were divided into two groups based on the presence of appendiceal endometriosis. Women with a history of appendectomy were excluded.

Measurements And Main Results: Four hundred-sixty patients were included for data analysis. The prevalence of appendiceal endometriosis was 2.8%. In patients affected by endometriosis of the appendix, concomitant ovarian and/or bladder endometriosis were more frequently encountered, with prevalence of 53.9% (vs 21.0% in non-appendiceal endometriosis group, p = 0.005) and 38.4% (vs 11.4%, p = 0.003), respectively. Isolated ovarian endometriosis was significantly associated to appendiceal disease compared to isolated uterosacral ligament (USL) endometriosis or USL and ovarian endometriosis combined (46.2% vs 15.4% vs 7.7%, p < 0.001). Poisson regression analysis revealed a 4.1-fold and 4.4-fold higher risk of ovarian and bladder endometriosis, respectively, and a 0.1-fold risk of concomitant USL endometriosis in patients with appendiceal involvement.

Conclusion: Involvement of the appendix is not uncommon among patients undergoing endometriosis surgery. Significant association was detected between appendiceal, ovarian, and bladder endometriosis that may be explained by disease dissemination coming from endometrioma fluid shedding. Given the prevalence of appendiceal involvement, counseling regarding the potential need for appendectomy during endometriosis surgery should be considered.

Citing Articles

Metabolomics for the identification of biomarkers in endometriosis.

Pandey S Arch Gynecol Obstet. 2024; 310(6):2823-2827.

PMID: 39496808 DOI: 10.1007/s00404-024-07796-5.

References

Vercellini P, Vigano P, Somigliana E, Fedele L . Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2013; 10(5):261-75. DOI: 10.1038/nrendo.2013.255. View

Afors K, Centini G, Fernandes R, Murtada R, Zupi E, Akladios C . Segmental and Discoid Resection are Preferential to Bowel Shaving for Medium-Term Symptomatic Relief in Patients With Bowel Endometriosis. J Minim Invasive Gynecol. 2016; 23(7):1123-1129. DOI: 10.1016/j.jmig.2016.08.813. View

Vercellini P, Sergenti G, Buggio L, Frattaruolo M, Dridi D, Berlanda N . Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol. 2020; 71:78-99. DOI: 10.1016/j.bpobgyn.2020.06.004. View

Gustofson R, Kim N, Liu S, Stratton P . Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril. 2006; 86(2):298-303. DOI: 10.1016/j.fertnstert.2005.12.076. View

Uohara J, Kovara T . Endometriosis of the appendix. Report of twelve cases and review of the literature. Am J Obstet Gynecol. 1975; 121(3):423-6. DOI: 10.1016/0002-9378(75)90026-5. View

Berker B, Lashay N, Davarpanah R, Marziali M, Nezhat C, Nezhat C . Laparoscopic appendectomy in patients with endometriosis. J Minim Invasive Gynecol. 2005; 12(3):206-9. DOI: 10.1016/j.jmig.2005.03.003. View

Alabiso G, Alio L, Arena S, Barbasetti Di Prun A, Bergamini V, Berlanda N . How to Manage Bowel Endometriosis: The ETIC Approach. J Minim Invasive Gynecol. 2015; 22(4):517-29. DOI: 10.1016/j.jmig.2015.01.021. View

Mabrouk M, Raimondo D, Mastronardi M, Raimondo I, Del Forno S, Arena A . Endometriosis of the Appendix: When to Predict and How to Manage-A Multivariate Analysis of 1935 Endometriosis Cases. J Minim Invasive Gynecol. 2019; 27(1):100-106. DOI: 10.1016/j.jmig.2019.02.015. View

Afors K, Murtada R, Centini G, Fernandes R, Meza C, Castellano J . Employing laparoscopic surgery for endometriosis. Womens Health (Lond). 2014; 10(4):431-43. DOI: 10.2217/whe.14.28. View

10.

Breivik H, Borchgrevink P, Allen S, Rosseland L, Romundstad L, Hals E . Assessment of pain. Br J Anaesth. 2008; 101(1):17-24. DOI: 10.1093/bja/aen103. View

11.

Allahqoli L, Mazidimoradi A, Momenimovahed Z, Gunther V, Ackermann J, Salehiniya H . Appendiceal Endometriosis: A Comprehensive Review of the Literature. Diagnostics (Basel). 2023; 13(11). PMC: 10253163. DOI: 10.3390/diagnostics13111827. View

12.

Padovesi Mota I, Klajner S, da Costa Goncalves M, Passman L, Podgaec S . Appendiceal Nodules in the Setting of Endometriosis Can Be Carcinoid Tumors. JSLS. 2015; 19(3). PMC: 4489857. DOI: 10.4293/JSLS.2015.00028. View

13.

Hori T, Harada H, Yamamoto M, Yamada M, Yazawa T, Sasaki B . Ectopic endometriosis, menstruation, and acute appendicitis: A thought-provoking case. Int J Surg Case Rep. 2021; 80:105605. PMC: 7893425. DOI: 10.1016/j.ijscr.2021.01.099. View

14.

Raimondo D, Borghese G, Cocchi L, Raffone A, Casadio P, Mollo A . Laparoscopic Appendectomy for Gynecologists in Five Steps. Gynecol Minim Invasive Ther. 2023; 12(3):183-184. PMC: 10553604. DOI: 10.4103/gmit.gmit_115_22. View

15.

Exacoustos C, De Felice G, Pizzo A, Morosetti G, Lazzeri L, Centini G . Isolated Ovarian Endometrioma: A History Between Myth and Reality. J Minim Invasive Gynecol. 2018; 25(5):884-891. DOI: 10.1016/j.jmig.2017.12.026. View

16.

Nisolle M, Donnez J . Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997; 68(4):585-96. DOI: 10.1016/s0015-0282(97)00191-x. View

17.

Xu X, Chen Y, Yu Q, Wang J, Xu P, Zhu L . The presence of living endometrial cells in ovarian endometriotic cyst fluid may contribute to the recurrence of endometriosis after surgical excision of endometriomas. J Ovarian Res. 2022; 15(1):89. PMC: 9338681. DOI: 10.1186/s13048-022-01018-9. View

18.

Donnez J, Spada F, Squifflet J, Nisolle M . Bladder endometriosis must be considered as bladder adenomyosis. Fertil Steril. 2000; 74(6):1175-81. DOI: 10.1016/s0015-0282(00)01584-3. View

19.

Somigliana E, Vercellini P, Gattei U, Chopin N, Chiodo I, Chapron C . Bladder endometriosis: getting closer and closer to the unifying metastatic hypothesis. Fertil Steril. 2007; 87(6):1287-90. DOI: 10.1016/j.fertnstert.2006.11.090. View

20.

Villaescusa M, Andres M, Amaral A, Barbosa R, Abrao M . Endometriosis and its correlation with carcinoid tumor of the appendix: a systematic review. Minerva Obstet Gynecol. 2021; 73(5):606-613. DOI: 10.23736/S2724-606X.21.04792-4. View