A Case of Chronic Appendiceal Intussusception Secondary to Unsuspected Endometriosis

Authors

Matthew Lee, HCA HealthcareFollow
Susana Ferra, HCA HealtchareFollow

Files

Division

East Florida

Hospital

HCA Florida Westside Hospital

Specialty

Pathology

Document Type

Poster

Publication Date

2024

Keywords

intussusception, intestinal obstruction, pathology

Disciplines

Digestive System Diseases | Medicine and Health Sciences | Pathology

Abstract

Introduction: Intussusception of the appendix is an exceedingly rare pathology with an incidence of 0.01%.

Case Summary: Patient is a 55 y/o female with appendiceal intussusception on CT and endoscopy. She was admitted for elective laparoscopic appendectomy, a distorted area involving the cecum and terminal ileum was identified. Procedure was converted to an open ileocolic resection due to the unclear anatomy and concern for possible malignancy. An intraoperative consultation revealed an inverted appendix.

Results: Gross examination of the specimen showed a structure protruding into the cecum lumen with an intact mucosal surface. Microscopic examination revealed a central fibromuscular core with adipose tissue covered by colonic type mucosa. Dilated glandular structures in the submucosa, displayed no morphologic nuclear features of malignancy. Endometriosis was confirmed by immunohistochemistry. The case was concluded as inverted appendix secondary to endometriosis.

Discussion: Appendiceal intussusception can be caused by mucocele, parasite, malignancy, and lymphoid hyperplasia. Endometriosis is a rare cause of appendiceal intussusception and defined as the implantation of endometrial glands and stroma within foreign tissues of the body. CT is the imaging modality of choice and may show invaginated appendix as a hollow tube within the cecum. Colonoscopy allows for direct visualization. Surgical removal is the mainstay of treatment.

Conclusion: Appendiceal intussusception presents a diagnostic challenge for surgeons, but should be included in the differential for right lower quadrant abdominal pain. Diagnosis is critical to rule out a malignant cause. Surgical intervention is an effective method to diagnose appendiceal intussusception the underlying etiology definitively.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Lee, Matthew and Ferra, Susana, "A Case of Chronic Appendiceal Intussusception Secondary to Unsuspected Endometriosis" (2024). East Florida Division GME Research Day 2024. 5.
https://scholarlycommons.hcahealthcare.com/eastflorida2024/5