Minimum Invasive Surgery for Appendiceal Intussusception Caused by Isolated Endometriosis; Surgical Technique for an Unreturned Case

Abstract

Introduction

Appendiceal intussusception is extremely rare, occurring in 0.01% of cases of appendicitis. Endometriosis-related intussusception is the most common in adults. Most reported cases require extensive surgery, such as ileocecal resection or right hemicolectomy. This case presents a minimally invasive surgical approach, involving partial cecal resection for an unreturned case.

Materials and Surgical Technique

A 47-year-old female presented with upper abdominal pain lasting 2 weeks. Examination revealed tenderness in the right lower quadrant. Imaging confirmed appendiceal intussusception with cecal involvement. Attempts at endoscopic reduction failed, necessitating laparoscopic intervention. The appendix was inaccessible laparoscopically and required extracorporeal manipulation. Due to fixation, intussusception was irreparable. A partial cecal resection with appendectomy was performed. The patient had an uneventful recovery and was discharged on postoperative day two. Histology confirmed endometriosis at the appendiceal tip.

Discussion

This case of endometriosis-induced Type V appendiceal intussusception involved complete inversion of the cecum. Unlike most cases that result in extensive resections, our approach demonstrated the feasibility of less invasive surgery. Endometriosis, although an uncommon cause of intussusception, should be considered in differential diagnoses, and CA125 may be a useful diagnostic marker. This case highlights that minimally invasive techniques, including appendectomy with partial cecal resection, should be prioritized in nonreducible cases without malignancy. Individualized, less invasive interventions offer significant benefits for patient recovery and outcomes.