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

Ahn CH, Chang Hyeok Ahn, Heejeong Lee, Lee H, Min Jeong Kim, Kim MJ, Na Rae Kim, Kim NR
Gynecologic and obstetric investigation · 2026 · pp. 1 · doi:10.1159/goi/aczag004 · PMID:42671979 · W7204903750
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This case report describes the first instance of a cecal traction diverticulum caused by endometriosis-driven smooth muscle hypertrophy and fibrosis, highlighting the condition as a differential diagnosis for cecal masses in reproductive-aged women.

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Abstract

OBJECTIVES: Cecoappendiceal endometriosis is rare and frequently mimics colorectal neoplasia, making preoperative diagnosis challenging. We report the first documented case of a true cecal traction diverticulum caused directly by endometriosis-associated smooth muscle hypertrophy and subserosal fibrosis. CASE PRESENTATION: 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. CONCLUSION: 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.

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