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Introduction: Endometriosis is established as the presence of ectopic endometrial tissue, outside the lining of the uterine cavity. Endometriosis of the appendix is uncommon especially in our environment. A definitive diagnosis is customarily established following histo-pathological examination of the appendix. Complications include rupture and haemorrhage.
The Case: A fifty-three years old female was admitted at the Jos University Teaching Hospital emergency unit, complaining of right lower abdominal pain of three days duration and abdominal distension of one week duration. The pain was associated with nausea, vomiting and fever (38.9°C). Abdominal examination showed generalised distension with guarding and tenderness especially at the lower abdomen with positive rebound tenderness. An exploratory laparotomy was done which showed copious pus in the peritoneal cavity. Appendectomy was done, and the peritoneal cavity was copiously lavaged.
Pathomorphology: Grossly, the appendix measured 6.5 by 1.7 by 1 cm with a lack lustre appearance and unremarkable serosa. Microscopically the muscularis propria show multiple islands of typical endometrial glands surrounded by a cellular endometrial stroma.
Conclusion: In conclusion, endometriosis of the appendix can imitate acute appendicitis and it should always be considered in the differential diagnosis of women complaining of nonspecific lower abdominal pain.