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Dave HB, Chamié LP, Young SW, Sakala MD, VanBuren WM, Jha P, Shen L, Pectasides M, Movilla P, Laifer-Narin S, Glanc P, Shenoy-Bhangle AS. Bowel Endometriosis: Systematic Approach to Diagnosis with US and MRI. Radiographics 2025; 45:e240102. [PMID: 40111900 DOI: 10.1148/rg.240102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
Endometriosis involving the bowel is a severe form of the disease, and the bowel is the most common site of extragenital endometriosis. Surface lesions of the bowel are considered peritoneal disease. Bowel endometriosis (BE) is defined as endometriotic tissue infiltrating the muscularis propria layer of the bowel wall. BE is estimated to affect up to 37% of patients with known deep endometriosis, highlighting its coexistence with genital endometriosis. The rectosigmoid colon is the most common segment of the bowel involved, followed by the distal small bowel. US and MRI are the most common imaging modalities used to detect BE. Depending on which bowel segment is imaged, endometriosis protocols for transvaginal US after bowel preparation with a transabdominal component and MRI and MR enterography are most commonly used. The authors provide a systematic approach to the diagnosis of BE using these imaging modalities. Imaging protocols and techniques for optimization of visualization of the bowel are discussed, the normal bowel wall anatomy with both imaging modalities is described, and the varying degrees of bowel wall involvement in endometriosis are illustrated. The imaging features of infiltration of endometriosis in the bowel muscularis propria are described in detail, along with key imaging findings to be conveyed to surgical colleagues to optimize surgical treatment and decrease complications, thereby improving overall patient outcomes. ©RSNA, 2025 Supplemental material is available for this article.
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Affiliation(s)
- Haatal B Dave
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Luciana P Chamié
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Scott W Young
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Michelle D Sakala
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Wendaline M VanBuren
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Priyanka Jha
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Luyao Shen
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Melina Pectasides
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Peter Movilla
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Sherelle Laifer-Narin
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Phyllis Glanc
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
| | - Anuradha S Shenoy-Bhangle
- From the Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095 (H.B.D.); Department of Radiology, Chamié Imagem da Mulher, São Paulo, Brazil (L.P.C.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (S.W.Y.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.D.S.); Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J., L.S.); Department of Radiology, Emory University, Atlanta, Ga (M.P.); Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Newton, Mass (P.M.); Department of Radiology, Columbia University, New York, NY (S.L.N.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (P.G.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.S.S.B.)
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Arsalan HM, Mumtaz H, Lagana AS. Biomarkers of endometriosis. Adv Clin Chem 2025; 126:73-120. [PMID: 40185537 DOI: 10.1016/bs.acc.2025.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2025]
Abstract
Endometriosis represents a diverse disease characterized by three distinct phenotypes: superficial peritoneal lesions, ovarian endometriomas, and deep infiltrating endometriosis. The most widely accepted pathophysiological hypothesis for endometriosis is rooted in retrograde menstruation, a phenomenon observed in most patients. Endometriosis is closely linked to infertility, but having endometriosis does not necessarily imply infertility. The disease can impact fertility through various mechanisms affecting the pelvic cavity, ovaries, and the uterus itself. MicroRNAs (miRNAs) indeed represent a fascinating and essential component of the regulatory machinery within cells. Discovered in the early 1990s, miRNAs have since been identified as critical players in gene expression control. Unfortunately, ovarian endometrioma is a common gynecologic disorder for which specific serum markers are currently lacking. Some have examined urocortin for its ability to differentiate endometriomas from other benign ovarian cysts. Another potential marker, Cancer Antigen 125 (CA-125) is a well-established indicator for epithelial cell ovarian cancer and its levels can be elevated in conditions such as endometriosis. CA-125 is derived from coelomic epithelia, including the endometrium, fallopian tube, ovary, and peritoneum. In this review we examine the pathophysiologic basis for endometriosis and highlight potential markers to more fully characterize the underlying biochemical processes linked to this multifaceted disease state.
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Affiliation(s)
- Hafiz Muhammad Arsalan
- Faculty of General Medicine, Altamimi International Medical University, Bishkek, Kyrgyzstan.
| | - Hina Mumtaz
- Department of Biochemistry, University of Central Punjab, Lahore, Pakistan.
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Ferrero S, Leone Roberti Maggiore U, Paudice M, Vellone VG, Perrone U, Barra F. Safety and efficacy of pharmacotherapies for pelvic inflammatory disease and endometriosis. Expert Opin Drug Saf 2025; 24:273-286. [PMID: 39718298 DOI: 10.1080/14740338.2024.2446424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 12/19/2024] [Indexed: 12/25/2024]
Abstract
INTRODUCTION Endometriosis and pelvic inflammatory disease (PID) are gynecological conditions affecting women of reproductive age and causing pain symptoms. The symptoms caused by these conditions are similar; thus, the differential diagnosis may be challenging. The treatment of these conditions is very different because PID is treated with antibiotic therapy, while endometriosis is treated with hormonal therapies suppressing estrogen levels. AREAS COVERED A narrative review was conducted through a comprehensive literature search on endometriosis and PID. The search strategy incorporated relevant keywords and MeSH terms related to these topics. EXPERT OPINION The antibiotics used to manage PID have high efficacy and safety profiles. Commonly prescribed regimens include a combination of ceftriaxone, doxycycline, and metronidazole. These antibiotics are generally well-tolerated, with most adverse effects being mild and manageable (gastrointestinal disturbances or hypersensitivity reactions). Hormonal therapies are a cornerstone in the management of endometriosis; they include combined oral contraceptives (COCs), progestins, gonadotropin-releasing hormone (GnRH) agonists, and antagonists. COCs and progestins are generally well-tolerated with a favorable safety profile, though they may cause side effects (breakthrough bleeding and mood changes). Oral GnRH antagonists have emerged as a noteworthy option, offering partial estrogen suppression and thereby overcoming the limitations associated with previously used GnRH agonists.
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Affiliation(s)
- Simone Ferrero
- Clinica Ostetrica e Ginecologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | | | - Michele Paudice
- Clinica Ostetrica e Ginecologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Integrated Diagnostic and Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Valerio Gaetano Vellone
- Department of Integrated Diagnostic and Surgical Sciences (DISC), University of Genoa, Genoa, Italy
- Pathology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Umberto Perrone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Fabio Barra
- Unit of Obstetrics and Gynecology, Genoa, Italy
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Bolcatto A, Erina M, Mandojana FI, Bruera N, Doniquian AM, Viscido GR. Acute appendicitis due to appendiceal endometriosis: Two case report and literature review. Int J Surg Case Rep 2025; 126:110743. [PMID: 39700583 PMCID: PMC11722600 DOI: 10.1016/j.ijscr.2024.110743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 12/08/2024] [Accepted: 12/11/2024] [Indexed: 12/21/2024] Open
Abstract
INTRODUCTION Appendiceal endometriosis (AE) is a rare condition, with a prevalence ranging from 0.05 % to 1.7 % in patients with endometriosis. It represents <1 % of cases of acute appendicitis (AA). CASES PRESENTATION We present two cases of AA where the histological cause was endometriosis. Both cases involved patients around 40 years old who presented with abdominal pain in the right iliac fossa. AA was diagnosed through abdominal computed tomography (CT), which in the first case showed acute appendicitis, successfully treated with laparoscopic appendectomy. In the second case, the CT showed signs of an appendiceal phlegmon, initially treated non-operatively with poor response, leading to exploratory laparoscopy and abscess drainage 48 h later. Subsequently, a scheduled laparoscopic appendectomy was performed after 6 months. Histopathological diagnosis in both cases was AA due to AE with endometrial glands showing recent bleeding, causing hyperplasia of the appendiceal muscular layer. DISCUSSION Endometriosis, characterized by the presence of endometrial tissue outside the uterine cavity, can rarely affect the appendix, termed AE. AE, though uncommon, poses diagnostic challenges due to nonspecific imaging findings and variable presentations, ranging from asymptomatic cases to AA. Histological evaluation post-appendectomy is definitive for diagnosis. AE is associated with right-sided pelvic involvement and often requires surgical management, with appendectomy typically resolving acute symptoms. However, recurrence of cyclical pain due to pelvic endometriosis may persist, underscoring the importance of comprehensive evaluation during laparoscopic procedures. CONCLUSION AA caused by AE is an uncommon condition, with very difficult preoperative diagnosis based solely on personal history, clinical presentation, and even imaging studies. It should be considered in differential diagnoses for women of reproductive age with associated pelvic endometriosis, although the recommended treatment in all cases is surgical.
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Affiliation(s)
| | - Melisa Erina
- Clinica Universitaria Reina Fabiola, Córdoba, Argentina.
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Yagur Y, Choi S, Robertson JA, Donohoe O, Almoqren M, Chou D, Rosen DMB. Should an Interval Appendicectomy Be Performed by a Minimally Invasive Gynaecologist? Int J Womens Health 2024; 16:2311-2318. [PMID: 39742346 PMCID: PMC11687302 DOI: 10.2147/ijwh.s487035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 12/12/2024] [Indexed: 01/03/2025] Open
Abstract
Objective We aimed to explore the abnormal pathology findings in appendix specimens removed based on intraoperative abnormal appearance during elective surgery for benign gynaecological conditions by a minimally invasive gynaecologist, as well as the associated complication rate. Materials and Methods This retrospective cohort study was conducted in a tertiary referral surgical centre for benign gynaecological conditions between the years 2004-2023. It included patients who underwent appendicectomy by a trained minimally invasive gynaecologist based on observations during surgery for benign gynaecological conditions. Data included demographic, clinical, surgical and pathological information followed by postoperative complication data obtained from electronic medical records and direct communication with surgical colleagues. The primary outcome was the evaluation of the abnormal pathological findings in the appendix. The secondary outcome was the complication rate associated with appendicectomy in these cases. Results The study cohort included 34 women who met inclusion criteria and underwent a laparoscopic surgery for endometriosis, chronic pelvic pain or a benign ovarian mass. Indications for appendicectomy included twelve cases (38.2%) with apparent appendiceal immobility (stiffness), fourteen cases (41.2%) with an appendix adherent to ovaries or the pelvic side walls, and seven cases (20.6%) with an abnormal appearance (large, wide, long, coiled, or curved). Pathological findings revealed six cases (17.6%) of acute or chronic appendicitis, four cases (11.8%) of endometriosis, five cases (14.7%) of abnormal pathological conditions, and three cases (8.8%) of cancer (two cases of well-differentiated adenocarcinoma and one case of low-grade appendiceal mucinous cystadenoma). Postoperative complication rate was 5.8% (two cases). Conclusion This study supports incorporating appendicectomy by trained gynaecological specialists during gynaecological elective surgery when abnormal findings are encountered. Further research and guidelines in this area can provide even greater clarity and direction for the future of gynaecological surgical practice.
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Affiliation(s)
- Yael Yagur
- Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Choi
- Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Jessica A Robertson
- Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Orla Donohoe
- Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Mohammed Almoqren
- Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Danny Chou
- Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - David M B Rosen
- Sydney Women’s Endosurgery Centre (SWEC), St George Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
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Pagano F, Dedes I, Imboden S, Mueller MD. Connecting the dots: Exploring appendiceal endometriosis in women with diaphragmatic endometriosis. Eur J Obstet Gynecol Reprod Biol 2024; 302:134-140. [PMID: 39265199 DOI: 10.1016/j.ejogrb.2024.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/23/2024] [Accepted: 08/30/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVES This study aims to ascertain the prevalence of appendiceal endometriosis (AppE) in patients diagnosed with diaphragmatic endometriosis (DiaE), compare it with the prevalence in patients without DiaE, and delineate the anatomical distribution of endometriotic lesions within these cohorts. STUDY DESIGN Comparison of the characteristics of patients with AppE and DiaE with the characteristics of patients with abdominal endometriosis without diaphragmatic involvement, in a prospective cohort study. SETTING Tertiary referral center; endometriosis center. PATIENTS A cohort of 1765 patients with histologically confirmed endometriosis INTERVENTIONS: Evaluation of correlations between demographic, clinical, and surgical variables of AppE patients with DiaE and without DiaE. We performed appendectomies selectively, in the presence of gross abnormalities of the appendix, such as endometriotic implants, edema, tortuosity, and discoloration of the organ. MEASUREMENTS Patients' characteristics were evaluated using basic descriptive statistics (chi-square test or Fisher's exact test). A logistic regression analysis was performed to evaluate the relationship (hazard ratio) between patient characteristics and the presence of DiaE and AppE. MAIN RESULTS Within a cohort of 1765 patients with histologically confirmed endometriosis, 31 were identified with AppE (1.8 %), and 83 with DiaE (4.7 %). The prevalence of DiaE was significantly elevated at 30.1 % (25/83), among patients with AppE compared to those without AppE, who showed a DiaE prevalence of 7.2 % (6/83). The calculated odds ratio for DiaE given the presence of AppE was 5.5, 95 % CI 2.1-14.4, p = 0.0004, and risk ratio was 4.2, 95 % CI 1.8-9.6, p = 0.0008, indicating a profound association. Surgical interventions did not lead to significant perioperative or postoperative complications. In the group with DiaE, the left ovary was affected in 96 % of cases (24/25), p < 0.05, the right ureter in 80 % of cases (20/25), p < 0.01 (in 19/25 only the serosa was affected, due to external compression of an endometriotic nodule of the parametrium). Concurrent AppE and right diaphragm was found in 92 % of cases (23/25 patients), p < 0.001. The concurrent presence of DiaE and AppE was often associated with severe endometriosis, rASRM IV 72 % OR = 3, 95 % CI (1.216-7.872). CONCLUSION The investigation delineates a marked association between AppE and DiaE, with an odds ratio of 5.5 and risk ratio of 4.2, suggesting a markedly increased likelihood of DiaE in patients with AppE. These statistics significantly substantiate the notion that AppE can serve as a predictive marker for DiaE, underscoring the necessity for a meticulous intraoperative assessment of diaphragmatic regions in patients diagnosed with AppE. The absence of a significant correlation between the depth of DiaE infiltration and the presence of AppE implies that the detection of AppE should prompt a thorough search for DiaE, regardless of the perceived severity of the endometriosis or preoperative results of diaphragmatic MRI.
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Affiliation(s)
- Flavia Pagano
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - Ioannis Dedes
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland
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Centini G, Ginetti A, Colombi I, Cannoni A, Giorgi M, Ferreira H, Fedele F, Pacifici M, Martire FG, Zupi E, Lazzeri L. Endometriosis of the appendix: prevalence, associated lesions, and proposal of pathogenetic hypotheses. A retrospective cohort study with prospectively collected data. Arch Gynecol Obstet 2024; 310:1669-1675. [PMID: 39143333 DOI: 10.1007/s00404-024-07650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/30/2024] [Indexed: 08/16/2024]
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.
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Affiliation(s)
- Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Alessandro Ginetti
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Irene Colombi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Alberto Cannoni
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Helder Ferreira
- Minimally Invasive Gynecological Surgery Unit of Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar Universidade do Porto, Porto, Portugal
| | - Francesco Fedele
- Department of Obstetrics and Gynecology, Fondazione "Policlinico-Mangiagalli-Regina Elena" University of Milan, Milan, Italy
| | - Martina Pacifici
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Francesco Giuseppe Martire
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy.
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynaecology, University of Siena, Siena, Italy
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Di Fabio F, Ravi P, Allievi N, Khan KA, Abduelraheim A, Moran B. Occult appendix pathology in patients undergoing colorectal cancer resection and prophylactic appendectomy. World J Surg 2024; 48:211-216. [PMID: 38651600 DOI: 10.1002/wjs.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND The risk-benefit balance of prophylactic appendectomy in patients undergoing left colorectal cancer resection is unclear. The aim of this report is to assess the proportion of histologically abnormal appendices in patients undergoing colorectal cancer resection in a unit where standard of care is appendectomy, with consent, when left-sided resection is performed. METHODS A retrospective study on a prospectively collected database was conducted in a single tertiary-care center. Overall, 717 consecutive patients undergoing colorectal cancer resection between January 2015 and June 2021 were analyzed. The primary outcome was the proportion of histologically abnormal appendix specimens at prophylactic appendectomy. The secondary outcome was complications from prophylactic appendectomy. RESULTS Overall, 576/717 (80%) patients had appendectomy at colorectal cancer surgery. In total, 234/576 (41%) had a right-/extended-right hemicolectomy or subtotal colectomy which incorporates appendectomy, and 342/576 (59%) had left-sided resection (left-hemicolectomy, anterior resection or abdominoperineal excision) with prophylactic appendectomy. At definitive histology, 534/576 (92.7%) had a normal appendix. The remaining 42/576 (7.3%) showed abnormal findings, including: 14/576 (2.4%) inflammatory appendix pathology, 2/576 (0.3%) endometriosis, 8/576 (1.4%) hyperplastic polyp, and 18/576 (3.1%) appendix tumors, which encompassed six low-grade appendiceal mucinous neoplasms (LAMNs), three carcinoids, and nine serrated polyps. In the 342 patients who had prophylactic appendectomy, 10 (2.9%) had a neoplasm (two LAMN, three carcinoids, and five serrated polyps). There were no complications attributable to appendectomy. CONCLUSION Occult appendix pathology in patients undergoing colorectal cancer resection is uncommon when prophylactic appendectomy was performed. However, approximately 3% of patients had a synchronous appendix neoplasm.
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Affiliation(s)
- Francesco Di Fabio
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Prabhu Ravi
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Niccolo Allievi
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Kashuf A Khan
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Abu Abduelraheim
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Brendan Moran
- Colorectal Surgery and Peritoneal Malignancy Unit, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Galaviz VD, Nguyen AD, Sticco PL, Downing KT. Appendectomy in endometriosis: an update on surgical indications and management of uncommon diseases. Curr Opin Obstet Gynecol 2023; 35:377-382. [PMID: 37144569 DOI: 10.1097/gco.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Abnormal appendiceal disease is commonly encountered following an appendectomy when performed in patients with endometriosis. Appendiceal endometriosis is the most notable finding and can affect up to 39% of patients with endometriosis. Despite this knowledge, guidelines for performing an appendectomy have not been formally established. In this article, we review the surgical indications for an appendectomy at the time of endometriosis surgery and discuss the management of other diseases that may be encountered following the histopathologic evaluation of an excised appendix. RECENT FINDINGS Removal of the appendix in patients with endometriosis contributes to optimal surgical management. Relying on abnormal appendiceal appearance for removal may leave endometriosis-affected appendices. For this reason, utilizing risk factors to guide surgical management is essential. Common appendiceal diseases are sufficiently managed with appendectomy. Uncommon diseases may require further surveillance. SUMMARY Emerging data in our field support the performance of an appendectomy at the time of endometriosis surgery. Guidelines for performing a concurrent appendectomy should be formalized to encourage preoperative counselling and management for patients with risk factors for appendiceal endometriosis. Abnormal diseases is frequently encountered after appendectomy in the setting of endometriosis surgery and further management is based on the histopathology of the specimen.
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Raimondo D, Borghese G, Cocchi L, Raffone A, Casadio P, Mollo A, Seracchioli R. Laparoscopic Appendectomy for Gynecologists in Five Steps. Gynecol Minim Invasive Ther 2023; 12:183-184. [PMID: 37807985 PMCID: PMC10553604 DOI: 10.4103/gmit.gmit_115_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/17/2022] [Accepted: 12/01/2022] [Indexed: 10/10/2023] Open
Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Giulia Borghese
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Laura Cocchi
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Antonio Mollo
- Department of Medicine, Surgery and Dentistry, Gynecology and Obstetrics Unit, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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Allahqoli L, Mazidimoradi A, Momenimovahed Z, Günther V, Ackermann J, Salehiniya H, Alkatout I. Appendiceal Endometriosis: A Comprehensive Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13111827. [PMID: 37296678 DOI: 10.3390/diagnostics13111827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Objective: the purpose of this review was to evaluate the prevalence of appendiceal endometriosis and the safety of concomitant appendectomy in women with endometriosis or pelvic pain. Materials and Methods: We searched the electronic databases Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was not subject to any limitation in terms of time or method. The primary research question was: what is the prevalence of appendiceal endometriosis? The secondary research question was: is it safe to perform appendectomy during surgery for endometriosis? Publications that reported data about appendiceal endometriosis or appendectomy in women with endometriosis were reviewed regarding the inclusion criteria. Results: We found 1418 records. After review and screening, we included 75 studies published between 1975 and 2021. With regard to the first question of the review, we found 65 eligible studies and divided these into the following two categories: (a) endometriosis of the appendix presenting as acute appendicitis, and (b) endometriosis of the appendix as an incidental finding in gynecological surgery. Forty-four case reports described appendiceal endometriosis in women who were admitted for the treatment of pain in the right-sided lower abdomen. Endometriosis of the appendix was observed in 2.67% (range, 0.36-23%) of women who were admitted due to acute appendicitis. In addition, appendiceal endometriosis was an incidental finding during gynecological surgery in 7.23% of cases (range, 1-44.3%). With regard to the second question of the review, which was the safety of appendectomy in women with endometriosis or pelvic pain, we found 11 eligible studies. Reviewed cases had no significant intraoperative or follow-up complications during the 12 weeks. Conclusion: Based on the reviewed studies, coincidental appendectomy appears reasonably safe and was associated with no complications in the cases reviewed for the present report.
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Affiliation(s)
- Leila Allahqoli
- Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, Qom University of Medical Sciences, Qom 3716993456, Iran
| | - Veronika Günther
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Johannes Ackermann
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
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12
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Raimondo D, Lazzeri L, Raffone A, Giorgi M, Orsini B, Verrelli L, Lenzi J, Travaglino A, De Meis L, Mollo A, Zupi E, Seracchioli R, Casadio P. Sonographic Assessment of Uterine Biometry for the Diagnosis of Diffuse Adenomyosis in a Tertiary Outpatient Clinic. J Pers Med 2022; 12:jpm12101572. [PMID: 36294711 PMCID: PMC9604640 DOI: 10.3390/jpm12101572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: to compare several uterine biometric parameters at transvaginal ultrasound (TVUS) between adenomyosis and non-adenomyosis uteri and evaluate their role for the diagnosis of diffuse adenomyosis. Methods: prospective observational study conducted between the 1 February 2022 and the 30 April 2022. In this case, 56 patients with TVUS diagnosis of adenomyosis were included. A 1:1 ratio age and parity-matched group of non-adenomyosis patients was selected. We compared sonographic uterine biometric parameters (longitudinal (LD), anteroposterior (APD) and transverse (TD) diameters, volume, simple and complex diameter ratios) and investigated their diagnostic performance. Results: all sonographic parameters were significantly different between the study groups, except for TD/(LD+APD). Optimal cut-off values of APD and LD/APD showed the best sensitivity and specificity. APD diameter equal or superior to 39.5 mm (95% CI, 36.2–42.8) had sensitivity of 0.70 (95% CI, 0.57–0.80), specificity of 0.71 (95% CI, 0.59–0.82) and accuracy of 0.75 (95% CI, 0.66–0.84). LD/APD equal or inferior to 2.05 (95% CI, 1.96–2.13) showed sensitivity and specificity of 0.70 (95% CI, 0.57–0.80) each and accuracy of 0.72 (95% CI, 0.62–0.81). Conclusions: several biometric uterine parameters at TVUS in fertile-aged women were statistically different between adenomyosis and non-adenomyosis uteri, though their optimal cut-off values showed low accuracy in diagnosing adenomyosis.
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Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Correspondence: or
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy
| | - Benedetta Orsini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Ludovica Verrelli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Antonio Travaglino
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Lucia De Meis
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, 84084 Baronissi, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Szymańska J, Dąbrowska-Galas M. An assessment of Polish women’s level of knowledge about endometriosis: a pilot study. BMC Womens Health 2021; 21:404. [PMID: 34876118 PMCID: PMC8650458 DOI: 10.1186/s12905-021-01556-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Insufficient knowledge about endometriosis among women is one of the causes of its delayed diagnoses. Due to the elusiveness of symptoms, the most important component of early detection is proper and exhaustive knowledge. The objective of the study was to assess Polish women's awareness of endometriosis.
Methods
The pilot studies were performed with the participation of 200 women, in an average age of 33.65 years (SD = 11.45), who completed the authors’ questionnaire related to self-assessment of the level of knowledge about the disease, its symptoms, late effects and directions of a remediation procedure. The statistical analysis was performed using the IBM SPSS Statistics 25 suite. It included a frequency analysis, a one-way analysis of variance ANOVA, a single variable regression analysis and Student’s t-test for independent samples.
Results
Almost 84% of women had heard about endometriosis, while only 1/3 of them considered their knowledge sufficient or good. Very good knowledge was declared by 4.5% of women, while 16.1% of participants had never heard about it. The level of knowledge was significantly higher (p = 0.001) among women with medical education. Polish women acquired their knowledge mainly from the Internet and the experience of other women. The reasons identified by women were the still existing ‘taboo’ related to menstruation, the absence of information in the media and education in schools, which is critical according to 92.4% of women.
Conclusions
Polish women’s level of knowledge about endometriosis is insufficient, which we should strive to improve. Higher awareness is presented by women with medical education, and the higher the level of knowledge, the larger a woman’s interest in healthy behaviour.
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Shichiri K, Nishida K, Lefor AK, Kubota T. Preoperative hormonal therapy for a patient with appendiceal endometriosis. BMJ Case Rep 2021; 14:e245667. [PMID: 34764095 PMCID: PMC8587620 DOI: 10.1136/bcr-2021-245667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/03/2022] Open
Abstract
The optimal management of patients with appendiceal endometriosis has not been determined because of the difficulty of establishing a preoperative diagnosis. There are no reports of preoperative hormone therapy for a patient with appendiceal endometriosis. We report a patient who underwent resection of appendiceal endometriosis after hormone therapy. A 40-year-old woman with history of recurrent pelvic abscesses presented to the emergency department with lower abdominal pain. The recurrent pelvic abscesses were synchronised with her menstrual cycle. CT scan demonstrated a 25 mm contrast-enhanced luminal structure adjacent to the cecum, which was thought to be a mucocele of the appendix. Considering the recurrent symptoms during menstruation, endometriosis was suspected. Treatment with a gonadotropin-releasing hormone agonist was started for appendiceal endometriosis, which alleviated the symptoms. After 3 months, elective laparoscopic appendectomy was performed. Preoperative hormonal therapy is an option for patients with appendiceal endometriosis, especially when there is concern for dense adhesions.
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Affiliation(s)
- Keiko Shichiri
- Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kazuhiro Nishida
- Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | | | - Tadao Kubota
- Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
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Araujo RSDC, Maia SB, Lúcio JD, de Lima MD, Ribeiro HSAA, Ribeiro PAAG. Mapping of endometriosis in patients with unilateral endometrioma. Medicine (Baltimore) 2021; 100:e26979. [PMID: 34414974 PMCID: PMC8376365 DOI: 10.1097/md.0000000000026979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/27/2021] [Indexed: 01/04/2023] Open
Abstract
To map the distribution of the sites most affected by endometriosis in patients with unilateral ovarian endometriomas.A descriptive case series of 84 patients with unilateral endometriomas undergoing laparoscopy for the treatment of endometriosis. To evaluate the distribution of the sites of endometriosis lesions, the peritoneal compartments were divided into 5 zones: zone 1/the anterior compartment, including the anterior uterine serosa, vesicouterine fold, round ligament, and bladder; zone 2/the lateral compartment, including the left and right ovary, ovarian fossa, tubes, mesosalpinx, uterosacral ligaments, parametrium, and the ureter; zone 3/the posterior compartment, including posterior uterine serosa, the pouch of Douglas, posterior vaginal fornix, and bowel; zone 4 consisting of the abdominal wall; and zone 5 consisting of the diaphragm.Of the 5 zones evaluated, the lateral compartment (zone 2) was the most affected, with 60.7% of the patients having dense adhesions around the left ovarian fossa and 57.1% around the right ovarian fossa. The ovarian endometriomas were more commonly found on the left side (54.8%) compared to the right (45.2%). In the posterior compartment (zone 3), the posterior cul-de-sac was obliterated in 51.2% of the patients. In the anterior compartment (zone 1), there were lesions in the vesicouterine fold in 30.9% of the patients and in the bladder in 19%. Lesions were found in the abdominal wall (zone 4) and diaphragm (zone 5) in 21.4% and 10.7% of patients, respectively.Unilateral endometriomas are important markers of the severity of endometriosis.
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Affiliation(s)
- Raquel Silveira da Cunha Araujo
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Sabina Bastos Maia
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Juliane Dornelas Lúcio
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Moisés Diogo de Lima
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Helizabet Salomão Abdalla Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Paulo Augusto Ayroza Galvão Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
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Nikou AF, Tenzel NS, Hua P, Orbuch L, Orbuch IK. Appendectomy Should Be Performed During Minimally Invasive Surgery for Endometriosis. JSLS 2021; 25:e2020.00095. [PMID: 33880001 PMCID: PMC8035829 DOI: 10.4293/jsls.2020.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To determine the prevalence of appendiceal histopathology in patients with confirmed endometriosis following minimally invasive surgery (MIS) for endometriosis. To determine whether pre-operative symptoms, age, intra-operative appendiceal appearance, or endometrioma laterality were associated with appendix histopathology in patients with suspected endometriosis. METHODS One hundred thirty-five patients ages 16-52 with suspected endometriosis undergoing MIS for endometriosis with concomitant appendectomy at two metropolitan academic hospitals from January 1, 2012 to June 30, 2017 were included in this retrospective chart-review study. Medical records were reviewed for pre-operative symptoms, age, intraoperative appendix appearance, appendix histopathology, histopathologically-confirmed endometriosis, and endometriomas. RESULTS In patients with confirmed endometriosis, the prevalence of all appendiceal histopathology was 25%, which included appendiceal endometriosis (18%), appendiceal tumors (2%), and inflammation (5%). Dyspareunia was the only pre-operative symptom significantly associated with appendiceal histopathology (p = 0.04). The presence of a right endometrioma was associated with appendiceal histopathology (p = 0.009). Additionally, appendiceal histopathology was not significantly associated with age nor intra-operative appendiceal characteristics. CONCLUSION This manuscript adds to the limited pool of studies regarding appendiceal histopathology and appendiceal tumors in patients with suspected and confirmed endometriosis. On the basis of the high rate of histopathological appendices found in this population; the lack of association with possible diagnostic factors such as age, most pre-operative symptoms, and intra-operative appendiceal characteristics; and the relatively low risks of concomitant appendectomy, we suggest that surgeons consider concomitant appendectomies at the time of MIS for endometriosis.
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Affiliation(s)
| | - Nicole Sara Tenzel
- Obstetrics, Gynecology, and Reproductive Science, Mt Sinai Health System, New York, NY
| | - Peiying Hua
- Population Health Science and Policy, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Laurence Orbuch
- Obstetrics, Gynecology, and Reproductive Science, Mt Sinai Health System, New York, NY
| | - Iris Kerin Orbuch
- Obstetrics, Gynecology, and Reproductive Science, Mt Sinai Health System, New York, NY
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Koninckx PR, Fernandes R, Ussia A, Schindler L, Wattiez A, Al-Suwaidi S, Amro B, Al-Maamari B, Hakim Z, Tahlak M. Pathogenesis Based Diagnosis and Treatment of Endometriosis. Front Endocrinol (Lausanne) 2021; 12:745548. [PMID: 34899597 PMCID: PMC8656967 DOI: 10.3389/fendo.2021.745548] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/26/2021] [Indexed: 12/18/2022] Open
Abstract
Understanding the pathophysiology of endometriosis is changing our diagnosis and treatment. Endometriosis lesions are clones of specific cells, with variable characteristics as aromatase activity and progesterone resistance. Therefore the GE theory postulates GE incidents to start endometriosis, which thus is different from implanted endometrium. The subsequent growth in the specific environment of the peritoneal cavity is associated with angiogenesis, inflammation, immunologic changes and bleeding in the lesions causing fibrosis. Fibrosis will stop the growth and lesions look burnt out. The pain caused by endometriosis lesions is variable: some lesions are not painful while other lesions cause neuroinflammation at distance up to 28 mm. Diagnosis of endometriosis is made by laparoscopy, following an experience guided clinical decision, based on history, symptoms, clinical exam and imaging. Biochemical markers are not useful. For deep endometriosis, imaging is important before surgery, notwithstanding rather poor predictive values when confidence limits, the prevalence of the disease and the absence of stratification of lesions by size, localization and depth of infiltration, are considered. Surgery of endometriosis is based on recognition and excision. Since the surrounding fibrosis belongs to the body with limited infiltration by endometriosis, a rim of fibrosis can be left without safety margins. For deep endometriosis, this results in a conservative excision eventually with discoid excision or short bowel resections. For cystic ovarian endometriosis superficial destruction, if complete, should be sufficient. Understanding pathophysiology is important for the discussion of early intervention during adolescence. Considering neuroinflammation at distance, the indication to explore large somatic nerves should be reconsidered. Also, medical therapy of endometriosis has to be reconsidered since the variability of lesions results in a variable response, some lesions not requiring estrogens for growth and some being progesterone resistant. If the onset of endometriosis is driven by oxidative stress from retrograde menstruation and the peritoneal microbiome, medical therapy could prevent new lesions and becomes indicated after surgery.
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Affiliation(s)
- Philippe R. Koninckx
- Latifa Hospital, Dubai, United Arab Emirates
- Prof Emeritus Obstet Gynecol (OBGYN), Catholic University Leuven (KU), Leuven, Belgium
- University of Oxford-Hon Consultant, Oxford, United Kingdom
- University Cattolica, Roma, Italy
- Moscow State University, Moscow, Russia
- Gruppo Italo Belga, Villa Del Rosario, Rome, Italy
- *Correspondence: Philippe R. Koninckx,
| | - Rodrigo Fernandes
- Instituto do Cancer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - Anastasia Ussia
- University Cattolica, Roma, Italy
- Gruppo Italo Belga, Villa Del Rosario, Rome, Italy
| | - Larissa Schindler
- Dubai Fertility Centre of the Dubai Health Authority, Dubai, United Arab Emirates
| | - Arnaud Wattiez
- Latifa Hospital, Dubai, United Arab Emirates
- Prof Department of Obstetrics and Gynaecology, University of Strasbourg, Strasbourg, France
| | | | | | | | | | - Muna Tahlak
- Latifa Hospital, Dubai, United Arab Emirates
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Acute Appendicitis Secondary to Appendiceal Endometriosis. Case Rep Surg 2020; 2020:8813184. [PMID: 33101752 PMCID: PMC7569452 DOI: 10.1155/2020/8813184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Endometriosis in the vermiform appendix is a rare condition that affects women of childbearing age. The clinical picture can simulate inflammatory acute abdominal pain, especially acute appendicitis. Laboratory and imaging tests may assist in the diagnosis but are not conclusive. This article reports a case of acute appendicitis caused by appendiceal endometriosis for which laparoscopic appendectomy and diagnostic confirmation were performed after histopathological analysis.
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Coratti F, Vannuccini S, Foppa C, Staderini F, Coratti A, Cianchi F, Petraglia F. Emergency surgery for appendectomy and incidental diagnosis of superficial peritoneal endometriosis in fertile age women. Reprod Biomed Online 2020; 41:729-733. [PMID: 32807657 DOI: 10.1016/j.rbmo.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION This study aimed to evaluate the presence of superficial peritoneal endometriosis (SUP) in women referred to emergency surgery for right iliac fossa (RIF) pain and undergoing an appendectomy, considering which factors may be useful to suspect and identify endometriosis. DESIGN An observational case-control study was conducted on a group (n = 149) of fertile age women. After surgery, Group A was selected upon the diagnosis of endometriosis (n = 34); Group B (n = 115) represented the controls. Demographics, comorbidities and clinical findings were registered and analysed. RESULTS Appendicitis of various grades of severity was diagnosed in all patients, but SUP was also identified in 23%, of which 14.7% also presented with endometriosis of the appendix. Women in Group A reported chronic pelvic pain, dysmenorrhoea, dyspareunia and oral contraceptive use more frequently. At multivariate analysis, factors associated with endometriosis were: age <40 years, autoimmune disorders, multiple allergies, abdominal chronic pain, associated gynaecological pain symptoms, Alvarado score ≤6, and inconclusive ultrasound findings. CONCLUSIONS The incidental finding of SUP in fertile age women presenting with an acute RIF pain and undergoing emergency surgery is a relevant observation. Clinical history and symptoms should guide surgeons in performing a correct diagnosis and in referring the patient to the gynaecology specialist.
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Affiliation(s)
- Francesco Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Silvia Vannuccini
- Department of Molecular and Developmental Medicine, University of Siena Siena, Italy; Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy
| | - Caterina Foppa
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Staderini
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Andrea Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy.
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Abstract
Deep invasive gastrointestinal endometriosis (DIGIE) is a frequent and severe presentation of endometriosis. Although most cases invade the rectosigmoid colon, DIGIE can involve any portion of the gastrointestinal tract from the stomach to the rectum, and is commonly multifocal and multicentric. Although histopathologic confirmation with surgery remains the gold standard for diagnosis, ultrasound (US) and magnetic resonance imaging (MRI) are the key non-invasive imaging modalities for initial assessment. US may be preferred as a screening study because of its easy availability and low-cost. Pelvic MRI and magnetic resonance enterography (MRE) provide substantial advantages for disease mapping in the pre-operative period, particularly in extensive bowel endometriosis. Although medical management of DIGIE with hormonal therapy can help control symptoms, disease course can be relentless and require surgical intervention. Surgical options depend on, the location; length; depth; circumference; multicentric or multifocal disease. With procedures including simple excision, fulguration of superficial lesions, shaving, disc excision, and segmental resection. A successful treatment outcome is largely dependent on good communication between the treating surgeon and the radiologist, who can provide vital information for effective surgical planning by reporting the key elements that we elaborate upon in this paper.
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Kwok H, Jiang H, Li T, Yang H, Fei H, Cheng L, Yao S, Chen S. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC WOMENS HEALTH 2020; 20:111. [PMID: 32434535 PMCID: PMC7240912 DOI: 10.1186/s12905-020-00974-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
Background To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and > 50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n = 184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n = 120 patients; 2.76 ± 1.52 vs. 2.33 ± 1.34; P = 0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P < 0.01) and vaginal (17.4% vs. 6.7%; P < 0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83 ± 1.56 vs. 2.74 ± 1.53; P = 0.678; and 2.65 ± 1.42 vs. 2.80 ± 1.43; P = 0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and > 50 mm. Conclusion Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
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Affiliation(s)
- Hungling Kwok
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Tian Li
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huan Yang
- Department of Gynecology, Shenzhen Second People's Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hui Fei
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Cheng
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Shuqin Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
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22
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Saleh M, Kim AF, Gardner A, Sun K, Brubaker S. Peritoneovaginal Fistula and Appendicitis-Related Pelvic Abscess in Pregnancy. AJP Rep 2020; 10:e129-e132. [PMID: 32309013 PMCID: PMC7159981 DOI: 10.1055/s-0040-1708849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 01/07/2023] Open
Abstract
Appendicitis in pregnancy is the most common nonobstetric surgical emergency. Pregnancy causes changes in anatomy, which could lead to uncertainty regarding the diagnosis of appendicitis. This case report describes a case of appendicitis presenting with peritoneovaginal fistula in a pregnant woman in the second trimester, with interesting finding of isolated appendiceal endometriosis on pathology. The importance of complete physical examination, including speculum examination, is emphasized in the pregnant patient presenting with acute-onset abdominal pain. Imaging criteria for diagnosis of appendicitis should be adjusted to account for the gravid uterus, which may cause appendiceal abscess to appear in a variety of locations, such as posterior to the cervix, as in this case.
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Affiliation(s)
- Mona Saleh
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
| | - Antonia Francis Kim
- Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Andrew Gardner
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
| | - Katherine Sun
- Department of Pathology, NYU Langone Health, New York, New York
| | - Sara Brubaker
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, New York
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Ferrero S, Moioli M, Dodero D, Barra F. Symptoms of Bowel Endometriosis. CLINICAL MANAGEMENT OF BOWEL ENDOMETRIOSIS 2020:33-39. [DOI: 10.1007/978-3-030-50446-5_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Ferrero S, Barra F, Altieri M, Orsi A, Icardi G, Noberasco G. Epidemiology of Bowel Endometriosis. CLINICAL MANAGEMENT OF BOWEL ENDOMETRIOSIS 2020:13-20. [DOI: 10.1007/978-3-030-50446-5_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Marcellin L, Leconte M, Gaujoux S, Santulli P, Borghese B, Chapron C, Dousset B. Associated ileocaecal location is a marker for greater severity of low rectal endometriosis. BJOG 2019; 126:1600-1608. [PMID: 31407476 DOI: 10.1111/1471-0528.15901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/23/2022]
Affiliation(s)
- L Marcellin
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - M Leconte
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
| | - S Gaujoux
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
| | - P Santulli
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - B Borghese
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - C Chapron
- Département de Gynécologie Obsétrique II et Médecine de la Reproduction (Professeur Chapron) Assistance Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire Paris Centre (HUPC) Paris France
- Université Paris Descartes Sorbonne Paris Cité Paris France
| | - B Dousset
- Université Paris Descartes Sorbonne Paris Cité Paris France
- Service de Chirurgie Digestive Hépato‐biliaire et Endocrinienne Assistance, Publique‐Hôpitaux de Paris (AP‐HP) Centre Hospitalier Universitaire (CHU) Cochin Hôpital Universitaire, Paris Centre (HUPC) Paris France
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26
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Zhu MY, Fei FM, Chen J, Zhou ZC, Wu B, Shen YY. Endometriosis of the duplex appendix: A case report and review of the literature. World J Clin Cases 2019; 7:2094-2102. [PMID: 31423443 PMCID: PMC6695541 DOI: 10.12998/wjcc.v7.i15.2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification. The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature. Endometriosis is a common gynecological disease that rarely occurs in the appendix. Moreover, horseshoe appendix combined with endometriosis has not been previously reported. CASE SUMMARY Here, we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain. Physical examination was consistent with the signs of acute appendicitis. The patient underwent an emergency exploratory laparotomy. The distal tip of the appendix was in contact with the cecum by another base, or "horseshoe appendix". In addition, a small intestinal mass and an ovarian mass were identified. Subsequently, appendectomy, partial resection of the small intestine, and right oophorectomy were successively performed. The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis, small intestine endometriosis, and ovarian endometriosis. CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy, and this study emphasizes the importance of exploring the entire abdomen.
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Affiliation(s)
- Ming-Yuan Zhu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Fa-Ming Fei
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhong-Cheng Zhou
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Bin Wu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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