Intussusception of the Cecal Appendix Secondary to Endometriosis: Case Report

Abstract Appendicular intussusception is the invagination of the appendix into the cecum. Endometriosis is the presence of endometrial tissue outside the uterine cavity, and it has a variable clinical picture, presenting as acute appendicitis or intestinal obstruction due to intussusception. The aim of the present paper is to report a case of cecal appendix intussusception secondary to endometriosis, since this is an extremely rare condition and there are few studies on the subject in the literature. We herein report the case of a 37-year-old female patient with deep endometriosis and abdominal pain in the right iliac fossa associated with menstruation. There was an intraluminal formation in the cecum, in the appendicular ostium. Magnetic resonance imaging showed foci compatible with ectopic endometrium in the uterus, rectum, and sigmoid colon. The cecal appendix was enlarged. Resection of the terminal ileum and cecum was performed, and the surgical specimen led to the diagnosis of appendicular intussusception and endometriosis of the cecal appendix. In adults, the most common etiologies of appendicular intussusception are endometriosis, mucocele, carcinoid tumors, and adenocarcinomas. In patients with endometriosis, involvement of the cecal appendix is infrequent. The definitive diagnosis is established by analyzing the surgical specimen, and imaging tests play a limited role in ruling out malignancies. Laparoscopic cecectomy is usually chosen, preserving the ileocecal valve. Hormone suppression therapy can prevent the recurrence of intestinal endometriosis. Appendicular intussusception, although an infrequent pathology, is an occurrence that requires surgical treatment and, in patients with endometriosis, it is important to include this hypothesis in the differential diagnosis.