Unlike the bowel, the appendix is much less commonly involved – perhaps in only 1:10 patients with proven rectal disease. The appendix, however, is frequently attributed as the cause of pain in the lower right side of the abdomen and many GPs, particularly those unfamiliar with endometriosis, wrongly attribute the pain to the appendix. Usually the right ovary is the source of the discomfort, particularly when it has become attached or even fused to the pelvic walls.
As with the bowel, appendiceal endometriosis forms on the outside of the appendix in almost all occasions. The appendix can be kinked or densely attached to other organs, and in these relatively uncommon situations, appendicectomy is the only option.
Any woman who is undergoing laparoscopic removal of the appendix (usually by a colorectal or general surgeon) should ask for a copy of images from the rest of the pelvis. Often there will be other important aspects of endometriosis that may require attention at a future stage under the care of Dr Gordon.