A RARE CASE OF APPENDICEAL INTUSSUSCEPTION

Introduction: Appendiceal intussusception is a very rare condition (0.01%) found in patients undergoing appendectomy. It happens when the appendix is pulled into itself or into the caecum. Endometriosis of the appendix is particularly a rare cause of appendiceal intussusception in the past 50 years, less than 30 cases have been reported in the literature. Clinical symptoms vary and some cases are asymptomatic.

Case Presentation: A 25 years old, female presented with complaints of periumbilical pain for 4-5 days, 6-7 episodes of bilious vomiting and constipation for 3 days. On examination, the abdomen was soft, mild tenderness was present in the periumbilical region. Patient was stable clinically. Ultrasound abdomen showed possibility of Ileo-colic Intussusception and intramural fibroid and CECT abdomen was suggestive of ileo-ileal intussusception and multiple uterine fibroids. Patient underwent Exploratory Laparotomy. Appendiceal intussusception was found in the caecum. Appendix and a part of caecum were found thickened and gangrenous. Ileocaecal junction and rest of the bowels were normal. Patient underwent ileocaecal resection with primary anastomosis.

Results: Histopathological report of specimen was consistent with findings of endometriosis of appendix with peri appendicular abscess and adenomatous changes in caecum.

Conclusion: Appendiceal intussusception to the caecum caused by endometriosis of the appendix is a very rare(0.01%) condition and difficult to diagnose preoperatively. It is usually diagnosed intra-operatively. Appendiceal intussusception due to endometriosis can only be confirmed by histopathology.