Abstract
Background: Acute appendicitis is the most common cause of acute abdomen. The etiology has not been defined clearly but potential causes are fecoliths, lymphoid hyperplasia and malignancies. However, an extremely uncommon cause of acute appendicitis is endometriosis which leads to dilemmas in the diagnostic process. Case report: A 21-year-old Caucasian female patient presented in the Emergency department complaining of acute progressive abdominal pain in the right lower quadrant. The physical examination revealed signs consistent with acute appendicitis. The patient underwent diagnostic laparoscopy, which revealed early inflammation of the appendix and thus was subjected to appendicectomy. Histologic examination revealed endometriosis of the appendix. Conclusion: The presented case emphasizes on how endometriosis can affect only the appendix without any involvement of the reproductive organs. A high index of clinical suspicion is required especially in women of reproductive age who present with periodic chronic pain associated with their menstrual cycle. Nonetheless, this can only be confirmed through diagnostic laparoscopy and histologic examination, which also provides the definite cure of the disease.
Highlights
Myocardial Infarction in the absence of obstructive coronary artery disease [MINOCA] is seen in 5-6% of the patients presenting with myocardial infarction and is more prevalent in females compared with males. [1][2] The disease entity was first identified 75 years ago when myocardial necrosis was reported in autopsies without the evidence of significant coronary atherosclerosis
Disease epidemiology Early angiographic studies by Likoff et al and Eliot et al reported the paradox of myocardial ischemia and necrosis in patients with normal coronary arteriograms. [4,5] Further angiographic studies by DeWood et al reported a prevalence of non-obstructive coronary arteries in nearly 5% of myocardial infarction patients undergoing angiography
Definition The European Society of Cardiology drafted the first international position article on MINOCA and defined MINOCA based on Third Universal Definition of Myocardial Infarction. [12,13] A recent scientific statement from the American Heart Association further refined the definition of MINOCA based on Fourth Universal Definition of Myocardial Infarction as: 1) Acute Myocardial Infarction as defined by Auctores Publishing – Volume 3(13)-113 www.auctoresonline.org
Summary
Myocardial Infarction in the absence of obstructive coronary artery disease [MINOCA] is seen in 5-6% of the patients presenting with myocardial infarction and is more prevalent in females compared with males. [1][2] The disease entity was first identified 75 years ago when myocardial necrosis was reported in autopsies without the evidence of significant coronary atherosclerosis. [3] Substantial variability exits in the manner patients with suspected MINOCA are evaluated and treated. Myocardial Infarction in the absence of obstructive coronary artery disease [MINOCA] is seen in 5-6% of the patients presenting with myocardial infarction and is more prevalent in females compared with males. [4,5] Further angiographic studies by DeWood et al reported a prevalence of non-obstructive coronary arteries in nearly 5% of myocardial infarction patients undergoing angiography. [6] These numbers were further sustained by individual studies and pooled analysis which reported similar prevalence of non-obstructive coronary arteries in myocardial infarction patients undergoing angiography. [7,8] While patients with MINOCA can present with either ST segment elevation or non-ST segment elevation myocardial infarction, they are less likely to have ST segment deviation on electrocardiography and have a smaller degree of cardiac biomarker elevation compared to their obstructive coronary artery disease counterparts. Etiology The underlying mechanisms for myocardial necrosis in patients presenting with MINOCA can be broadly classified into atherosclerotic and nonatherosclerotic causes. [1]
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