Appendical os endometeriosis: A rare cause for lower gastrointestinal bleeding

Excerpt

A 41-year-old lady with past medical history of appendectomy 20 years ago and abnormal uterine bleeding requiring total laparoscopic hysterectomy and right salpingo-oophrectomy (as the right ovary was noted to be adherent to posterior uterus) presented for colonoscopy for the evaluation of intermittent red blood mixed with stool. During colonoscopy, the os of the appendix was noted to have a polypoid appearance (Fig. 1) and biopsies were obtained. No other cause for bleeding was noted. Combined histopathology and immunohistochemistry revealed endometriosis involving the lamina propria of the colonic mucosa with overlying erosion and without evidence of epithelial dysplasia or invasive malignancy (Fig. 2). Computed tomography with intravenous (IV) contrast showed a 5.1 cm left adnexal cystic mass with septations and no other acute or new findings. The patient was referred to follow-up for discussions regarding medical and surgical options. Common sites of endometriosis (endometrium-like epithelium and/or stroma outside the endometrium or myometrium) include ovaries, fallopian tubes and peritoneum [1‐3]. The involvement of the gastrointestinal tract and the appendix is rare. The latter may be asymptomatic or present with pain, features of appendicitis, gastrointestinal hemorrhage or rarely intussusception. Even after appendectomy, residual tissue can continue to be symptomatic as in our case. Although clinical diagnosis can be challenging, the definitive diagnosis is established by histopathology as in our case. Treatment encompasses supportive care to medical management and surgery, which is typically required promptly in case of acute appendicitis [3].

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