The meso-appendix (the mesentery of the appendix) is normally located medial to the appendix with a free medial border. This case presents the incidental diagnosis and successful treatment of isolated meso-appendicular endometriosis with dense adhesions to the lateral pelvic wall, identified during laparoscopic management of stage IV endometriosis. We propose that the 2021 AAGL classification of pelvic endometriosis be updated to include meso-appendicular endometriosis with a score of 3 to better reflect its prevalence.
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