Cecoappendiceal Endometriosis Presenting as a Cecal Traction Diverticulum: A Case Report.

Authors

Chang Hyeok Ahn, Heejeong Lee, Min Jeong Kim, Na Rae Kim

Published in

Gynecologic and obstetric investigation. Pages 1. Aug 31, 2026. Epub Aug 31, 2026.

Abstract

Cecoappendiceal endometriosis is rare and frequently mimics colorectal neoplasia, making preoperative diagnosis challenging. We report the first documented case of a cecal traction true diverticulum caused directly by endometriosis-associated smooth muscle hypertrophy and subserosal fibrosis.
A 42-year-old nulliparous woman presented with an incidentally discovered malignant-appearing polypoid cecal mass on colonoscopy. Abdominal CT demonstrated a 1.5-cm enhancing lesion at the proximal appendix. Laparoscopic wedge resection of the cecum and appendix was performed. Histology revealed deep endometriosis (>5 mm) with dramatic smooth muscle hypertrophy (muscularis propria 12 mm vs. normal ∼0.37 mm; >30-fold increase) in both the cecum and appendix. A true traction diverticulum-confirmed histologically to contain all three bowel wall layers-had formed as a direct mechanical consequence of progressive endometriosis-driven hypertrophy and fibrosis. Immunohistochemistry demonstrated estrogen-receptor-positive glands and CD10-positive stroma; beta-catenin negativity excluded mesenteric fibromatosis.
This is the first documented case of endometriosis-induced cecal traction diverticulum, establishing a new mechanistic concept in intestinal endometriosis. Endometriosis-driven myoproliferation combined with subserosal fibrosis may generate sufficient mechanical traction to invert the cecal wall into a diverticular configuration. Endometriosis should be included in the differential diagnosis of cecal diverticular lesions in reproductive-aged women, and pelvic MRI should be considered for preoperative characterization before attributing such lesions to neoplasia or diverticulitis.

PMID:
42671979
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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