Atypical Appendicitis Mimicking Gynecological Pathology: A Diagnostic Challenge in a Middle-Aged Woman

BACKGROUND Appendicitis is a common surgical emergency, but the diagnosis may remain unclear and challenging, particularly in middle-aged women who present with atypical features. Atypical appendicitis, defined as appendiceal inflammation without classic migratory pain, nausea, or fever; it often mimics gynecological disorders, contributing to diagnostic delays. The present case is unique because it involved an unusually prolonged 2-month history of persistent suprapubic pain before acute exacerbation. Such a chronic course preceding the acute phase is uncommon and further complicated the diagnostic process, underscoring the need for clinical vigilance in prolonged, unexplained lower abdominal pain. CASE REPORT A 46-year-old woman presented with a 2-month history of persistent suprapubic pain without associated systemic symptoms. Her gynecological history included prolonged intrauterine copper device use and recent postcoital bleeding. Initial clinical evaluation suggested pelvic inflammatory disease, and empirical antibiotics provided minimal symptomatic relief. Laboratory investigations and imaging, including pelvic ultrasound and computed tomography, were inconclusive, demonstrating bilateral simple ovarian cysts and a minimally distended appendix with mild periappendiceal fat stranding. Due to worsening localized right lower abdominal pain and persistent symptoms, laparoscopic appendectomy was performed. Histopathology confirmed early acute appendicitis. The patient's postoperative recovery was uneventful. CONCLUSIONS This case underscores the need to maintain high clinical suspicion for appendicitis despite normal white blood cell counts and equivocal imaging, thereby supporting re-evaluation protocols for persistent abdominal pain.