Acute appendicitis and endometriosis: Retrospective analysis in emergency setting

Introduction. The aim of this study is to evaluate the incidence of appendiceal and pelvic endometriosis in a population with diagnosis of acute appendicitis in an emergency setting. Materials and methods. We carried out a retrospective study in the period between January 2010 and October 2013. We performed 429 appendectomy including 233 in female subjects (54.3%). In all patients of childbearing age, we did β-hCG urine test to rule out the presence of an extra-uterine pregnancy. Results. 127 of 233 patients received a laparoscopic approach (54.5%). The median age was 29 years-old (range 17-68). The diagnosis of appendiceal and/or pelvic endometriosis was performed in 10 patients (4.3%): 9 treated in laparoscopy and only 1 treated in open. In only one case was required conversion to open surgery. We diagnosed appendiceal endometriosis in 3 patients, pelvic endometriosis with consensual acute appendicitis in 5 cases, pelvic endometriosis in the absence of macroscopic changes of the appendix in one case, sigmoid endometriosis in one case. There were no intraoperative complications, wound's complications or intra-abdominal abscesses. Conclusions. In general female population with clinical, laboratoristic and instrumental diagnosis of acute appendicitis and without anamnestic suspicion of gynecological pathology, it is always good to consider the hypothesis of pelvic and/or appendiceal endometriosis. The laparoscopic approach should be considered the treatment of choice for these patients in an emergency setting.