Ectopic decidua of the appendix: a case report.

BACKGROUND: Ectopic decidua is the presence of decidual tissue outside the uterus. Ectopic decidua of the appendix is a rare entity that can present with abdominal symptoms mimicking appendicitis. We report a case of a 39-year-old female patient at 27 weeks gestational age with a 2-day history of right lower quadrant abdominal pain. CASE PRESENTATION: The patient was referred to our hospital with suspicion of either acute appendicitis or threatened rupture of the uterus, the latter of which was considered unlikely following close examination. Therefore, she underwent emergency appendectomy via laparotomy. Microscopic examination revealed decidual tissue with myxoid degeneration in the subserosal layer of the tip side of the appendix, without endometriosis, which was compatible with ectopic decidua (deciduosis). CONCLUSIONS: Because it is extremely difficult to distinguish ectopic decidua of the appendix from acute appendicitis, even with various imaging modalities, we should be aware that ectopic decidua of the appendix is a differential diagnosis for acute appendicitis in pregnant women.

Deciduosis of the Appendix During Pregnancy.

Acute appendicitis is an important differential diagnosis in patients with right lower quadrant pain during pregnancy. Endometriosis, a hormone-related pathology, is another possibility. Patients with endometriosis are typically symptomatic before pregnancy. Stromal endometriosis is a variant of endometriosis that presents no symptoms before pregnancy but which occasionally presents with the new onset of symptoms during pregnancy. We report the case of a 35-year-old woman in her 8th month of pregnancy who presented with impending appendiceal rupture due to deciduosis of the appendix, a progesterone-related condition, during pregnancy. This case suggests that deciduosis/stromal endometriosis should be considered as a differential diagnosis of acute abdomen during pregnancy, even if the patient is asymptomatic before pregnancy.

Clinical features of ectopic decidua in term gestation / 局解手术学杂志

Objective To explore the biological behavior and pathologic mechanism of ectopic decidua hemorrhage or acute postpartum hemorrhagic deciduosis caused by typical decidua tissue outside the uterine cavity under the influence of ovarian and placental hormones,and provide reference for accurate diagnosis and effective treatment. Methods From August 2017 to January 2018,there were 461 term-pregnant women undergoing ceasarian section in maternal and child health hospital of Qingbaijiang district,of whom 3 cases with ectopic deciduas were diagnosed.The clinical characteristics and microscopic features of 3 cases were retrospectively analyzed.The risk assessment to human health as well as effective control measures of ectopic deciduas were further elucidated along with the relevant references. Results Three patients with ectopic decidua generally had no obvious clinical symptoms or endometriosis,though dysmenorrheal and infertility might happen before pregnancy.Only an intraoperative incidentally finding of specific lesions varied from vacuolar plaques, hyperemia,vascular nodules, solid nodules and local hemorrhagic change.Under light microscope, the decidualized stroma revealed large polygonal cell aggregates, without nu-clear atypia.Due to the clinical features of abnormal angiogenesis and inflammatory reactions, ectopic decidua may cause severe cases such as acute postpartum hemorrhagic deciduosis,which could provide a basis for clinical comprehensive understanding and scientific prevention and treatment.Conclusion Ectopic decidua can happen in uterine seromuscular layers,ovary,great epiploon,cervix,vagina and so on,which is easy to be misdiagnosed or fails to be examined due to asymptom and nonspecific physical signs.It hasn’t been unequivocally clarified and widely recognized,nor earned extensively considered for rarely life-threatening haemorrhagic deciduosis in the prepartum and postpartum peri-od,which must be taken effective first-aid measures such as surgical intervention to protect maternal-fetal health.

Ileal perforation and massive intestinal haemorrhage from endometriosis in pregnancy: case report and literature review.

An increasing number of women with severe endometriosis have conceived through assisted reproductive technology, but endometriosis can cause life-threatening complications for both the mother and baby during pregnancy. We describe a case of endometriosis-induced spontaneous ileal perforation in pregnancy with massive intestinal haemorrhage that required caesarean section, right hemicolectomy and terminal ileum resection at 33 weeks of gestation. Spontaneous perforation associated with intestinal endometriosis in pregnancy is a rare complication, and only seven cases have been reported in the English literature. To the best of our knowledge, this is the first report of spontaneous ileal perforation due to endometriosis. Moreover, this is probably the first case of massive intestinal haemorrhage in pregnancy that resulted from intestinal endometriosis. These risks must be explained to couples suffering from endometriosis-related infertility prior to conception by assisted reproductive technology, and multidisciplinary management may be mandatory for women with severe endometriosis in pregnancy.