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|Year : 2011 | Volume
| Issue : 2 | Page : 135-136
Cecal endometriosis as an unusual cause of right iliac fossa pain
O Baraket, R Zribi, A Berriche, A Chokki
Department of General Surgery, Hospital of Siliana, Tunisia
|Date of Web Publication||4-Jun-2011|
Department of General Surgery, Hospital of Siliana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baraket O, Zribi R, Berriche A, Chokki A. Cecal endometriosis as an unusual cause of right iliac fossa pain. J Postgrad Med 2011;57:135-6
Endometriosis is defined as an ectopic proliferation of endometrial tissue outside the uterine cavity.  It is fairly common in childbearing women. Bowel involvement in endometriosis is uncommon and usually localized to the rectosigmoid and less frequently to the cecum.
A 24-year-old woman with no medical history was admitted to the hospital with a one-day history of right iliac fossa pain, nausea, and vomiting. Her menses had been irregular, with occasional dysmenorrhea. The abdominal examination revealed right lower quadrant tenderness. The white blood cell count was 10400/mm 3 . Abdominal ultrasonography was normal. A diagnosis of acute appendicitis was made clinically and the patient underwent laparoscopic exploration. The peritoneal cavity was clean. The wall of the cecum had a brown implant and plane mass, measuring 3 cm of diameter [Figure 1], [Figure 2] and [Figure 3]. No other similar implants were found. The uterus and the appendix were normal [Figure 4]. A standard right hemicolectomy was performed by laparotomy after consulting the gynecologist.
|Figure 1: Endometriosis involving the interior lateral wall of the cecum|
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|Figure 2: Endometriosis involving the interior lateral wall of the cecum|
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|Figure 3: Endometriosis involving the interior lateral wall of the cecum|
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The pathologic examination showed ectopic endometrial glands in the thickened muscular propria and the subserosa of the cecal wall. The mucosa was not involved. There was no microscopical evidence of acute appendicitis.
Patient's postoperative course was uneventful and she was addressed to gynecologist.
It has been estimated that 4 to 17% of all menstruating women have endometriosis; , bowel involvement occurs in 3 to 37% of the cases, with 3.5% of cecum localization. 
Clinically, cecal endometriosis may mimic a number of diseases such as Crohn's disease, appendicitis, tubo-ovarian abscess.  Also, it can take the form of chronic or recurrent abdominal pain, or dyschezia.  Hence, the differential diagnosis, especially in emergency setting, is difficult. Bowel troubles are usually cyclic and associated with the period. , Our patient presented clinically as acute appendicitis. Although, she had had irregular menses and occasional dysmenorrhea, cecal or appendiceal endometriosis was never suspected preoperatively. When she was questioned again postoperatively, she described similar pain two months ago but with no relationship between the pain, hemorrhage, and menstrual cycle and she had not had any other symptoms of endometriosis: constipation, dyschezia, etc.
As mucosal invasion by an endometrioma is quite rare, an accurate diagnosis is often difficult to make without surgery. Campacci et al. reported seven cases of colorectal endometriosis with a normal mucosa at colonoscopy in all cases. At the same time, there are no radiologic or diagnostic imaging findings that are specific for endometriosis.  The gold standard for the definitive diagnosis of endometriosis is laparoscopy. However, because of the heterogeneous appearance of the lesions, the accuracy of laparoscopic diagnosis depends on the ability of the surgeon to recognize the disease.  Unequivocal diagnosis requires microscopic examination.  In our case, endometriosis was not suspected on the macroscopic appearance. And, right hemicolectomy was performed to avoid neglecting a malignant tumor.
Although cecal endometriosis is rare, it should be considered in female patients with right lower quadrant pain. Surgery is still the treatment of choice to avoid neglecting malignant tumor and some complications such as perforation, bowel obstruction, or bleeding.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]