Background: While endometriosis has a high prevalence among women during their reproductive years, appendiceal endometriosis is an uncommon clinical condition that affects women, and it is mostly presented as acute appendicitis, and or similar to several other gynecological disorders.
Case Presentation: A thirty-four years old female presented with symptoms of a one-day of acute right lower quadrant (RLQ) pain as well as a chronic history of abdominal pain and chronic recurrent pelvic pain. The physical and clinical assessment referred for laboratory, the findings suggested acute appendicitis, then admitted to Baghdad teaching hospital for Laparoscopic appendectomy, and the specimen was sent for histopathological examination, where it revealed endometrial glands and stroma embedded in the muscularis propria of the appendix.
Conclusion: Although rare, appendiceal endometriosis should be considered in the differential diagnosis of RLQ pain in reproductive-age women. This case indicates the necessity of routine histopathological examination of all appendectomy specimens to ensure accurate diagnosis and appropriate follow-up.