2616 Concomitant Appendectomy in Patients with Pelvic Pain: Can we Predict Abnormal Appendiceal Pathology?

Abstract

Study Objective To determine the prevalence of appendix pathology (i.e. endometriosis, fibrous obliteration, tumor, acute/chronic inflammation) in patients with chronic pelvic pain. To determine whether preoperative symptoms, age (≤ 35 or >35), or intraoperative appendiceal appearance were associated with appendix pathology. Design Retrospective chart review. Setting Two Large Metropolitan Academic Hospitals. Patients or Participants 135 patients between the ages of 16 to 52 with chronic pelvic pain undergoing minimally invasive excision surgery with concomitant appendectomy for suspected endometriosis from January 2012 to June 2017. Interventions Data on appendix pathology, preoperative symptoms, age, and intraoperative appendix appearance was collected from medical records, operative reports, and postoperative pathology reports. Measurements and Main Results Among the 135 patients with chronic pelvic pain, 54 (40%, 95% CI:31.7-48.3%) had underlying abnormal appendiceal pathology: 18 (13.3%, 95% CI:7.6-19.1%) with endometriosis, 25 (18.5%, 95% CI:12.0-25.1%) with fibrous obliteration, 4 (3.0%, 95% CI:0.1-5.8%) with tumors, and 7 (5.2%, 95% CI:1.4-8.9%) with inflammation. Dyspareunia was the only statistically significant preoperative symptom that was associated with appendiceal pathology (p=0.04). Gastrointestinal symptoms (i.e. dyschezia, constipation, nausea, and diarrhea), dysmenorrhea, menorrhagia, dysuria, right lower quadrant pain, left lower quadrant pain, back pain, and presence of ovarian cyst were not significantly associated with appendiceal pathology. Rates of appendiceal pathology were not significantly different between age groups (≤ 35 vs >35) (p=0.24). Thickening, scarring/adhesions, discoloration, nodularity, vascular congestion, or irregular shape of the appendix were not significantly associated with underlying appendix pathology. Conclusion Neither age (≤ 35 or >35) nor intraoperative appendiceal appearance was associated with underlying appendiceal pathology, which had a prevalence of 40%. Only preoperative dyspareunia was associated with appendiceal pathology, a connection that requires further study. Thus surgeons should consider concomitant appendectomy in patients with chronic pelvic pain.