Design: N/A

Setting: Academic Hospital System

Patients or Participants: Our patient is a 49-year-old female with history of endometriosis status post prior hysterectomy and excision of endometriosis who was found to have an inverted appendix during work up for RLQ pain.

Interventions: Patient underwent laparoscopic lysis of adhesions, appendectomy and partial cecectomy. Extensive adhesiolysis was first performed in order to free the small bowel and mobilize the right cecum and appendix. The laparoscopic automatic GIA stapler was used to remove the inverted appendix and a small portion of cecum. The laparoscopic EndoCatch bag was used to retrieve specimens from the abdomen.

Measurements and Main Results: Patient underwent an uncomplicated laparoscopic lysis of adhesions, appendectomy and partial cecectomy. She was recovering well at their 2 week follow-up visit. Pathologic evaluation of the inverted appendix was consistent with endometriosis.

Conclusion: Appendiceal endometriosis is a rare cause of intussusception. Its presentation can be acute or more commonly with chronic non-specific symptoms. When the appendix is not considered in disease pathology for endometriosis, patients are at increased risk of unresolved pain and, thus, further laparoscopic procedures. Performing prophylactic appendectomy in patients with chronic pelvic pain and endometriosis could potentially be beneficial but more research is needed to determine the benefits and risks associated with this practice.