Abstract
Acute appendicitis remains one of the most common urgent surgical diseases of the abdominal cavity. Atypical variants of vermiform appendix localization significantly complicate clinical diagnosis and may lead to diagnostic errors and inappropriate surgical intervention.
Case report. A 33-year-old female patient was admitted to the emergency surgery department with complaints of right iliac pain lasting two days, abdominal bloating, nausea, and low-grade fever. Comorbid condition: chronic gastritis. In February 2025, she underwent laparoscopic myomectomy for multiple uterine fibroids. The abdomen was moderately tender in the right iliac region; peritoneal signs were equivocal. Complete blood count showed mild leukocytosis (9.80 × 10⁹/L) without a left shift.
Diagnostic laparoscopy revealed that the vermiform appendix was not visualized; however, deformation of the cecal dome and a small amount of clear effusion in the right iliac region were observed. Conversion to open surgery was performed. The cecal dome was of normal color without adhesions. A dense elastic mass measuring 3 × 3 × 4 cm was palpated within its wall. After opening the serosal layer over the indurated area, the appendix was identified within the submucosal layer of the cecal dome. It lacked a serosal covering and had a dark cherry color.
Histopathological examination revealed appendiceal endometriosis with signs of inflammation. The postoperative course was uneventful.