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OJHAS Vol. 9, Issue 4:
Oct-Dec, 2010) |
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Appendicocecal Fistula
– A Rare Complication of Appendicitis |
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Sajad Ahmad Salati, Ex- Registrar,
Ajaz Ahmad Rather,
Consultant,
Nazir Ahmad Lone, Ex- Registrar,
Adil Rashid, Ex- Registrar,
Department of Surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India |
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Address For Correspondence |
Lane 2, Bulbul Bagh,
Srinagar, Kashmir, India.
E-mail:
docsajad@yahoo.co.in |
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Salati SA, Rather AA, Lone NA, Rashid A. Appendicocecal Fistula
– A Rare Complication of Appendicitis. Online J Health Allied Scs.
2010;9(4):31 |
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Submitted: Oct 2,
2010; Accepted: Oct 15, 2010; Published: Jan 20, 2011 |
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| Abstract: |
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Fistulisation of appendix
to other organs or to the exterior through abdominal wall is a rare
complication of appendicitis. We present one such rare case of appendicocecal
fistula due to appendicitis in a patient initially managed conservatively
for appendicular lump.
Key Words: Appendicitis; Fistulae; Complication
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Appendicitis
is the most common cause of acute abdomen that requires emergency surgical
intervention. Complications like perforation, peritonitis and lump formation
are common due to delay in diagnosis. However complications like
fistula formation with other viscera are rare.1,2 These
spontaneous fistulae occur due to rupture of inflammed appendix into
these organs. Inflammed appendix gets adherent to these organs and bursts
spontaneously into these organs or to exterior through the abdominal
wall.3 But the inflammed appendicular tip rarely gets fixed
to bowel wall and hence appendico-enteric fistulae including appendicocaecal
fistulae are rarest entities in literature.4
A 40 years old man
was admitted with complaints of right iliac fossa pain with tenderness.
There was no other medical or surgical history of significance in the
past. On examination a tender lump was found in right iliac fossa and
was diagnosed as appendicular lump. This was confirmed by ultrasonography.Patient
was managed conservatively on intravenous fluids and intravenous antibiotics.
The lump regressed and patient was discharged after one week. He was
advised interval appendectomy after six weeks. At the time of appendectomy
it was found, that the tip of appendix was fixed to cecum and was inseparable.
The appendix was forming a horse shoe shaped configuration on the anterior
surface of cecum. After proper isolation of the operation field, the
appendix was divided in the middle (Fig 1) and as the cecum was squeezed
gut contents came from both the cut ends of the appendix. Then with
a blunt probe fistulous communication of appendix with cecum was confirmed.
Appendectomy was performed and both stumps were closed and buried into
cecum. Histopathological examination of the specimen of appendix ruled
out inflammatory bowel disease and malignancy. The patient made an uneventful
recovery.
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Fig 1: Horse shoe configuration with clamped cut ends of appendix
shown with black arrows |
Spontaneous appendiculocaecal
fistula is a very rare complication of acute appendicitis. Various types
of fistulae involving appendix reported in literature include appendicoenteric4, appendicoaortic5-7, appendicouterine, appendicotuboovarian2, appendicoureteric8, appendicoileovesical9, appendicovesical9, and appendicocutaneous1,10 fistulae. The
mechanism of formation of these fistulae has been described by the Kejellman3 as spontaneous rupture of inflammed appendix into the adjacent
bowl, bladder or skin. In acute appendicitis the tip is frequently adherent
to parenchymatous organs but fixation of inflamed appendix to the bowel
wall is rather an infrequent finding4 and fixation to cecum
to make a reentry is even rarer possibility. This makes appendiculocaecal
fistulas rarest among rare fistulas. The appendiculovesicular ,appediculocutaneous
and appendiculoaortic fistulae are symptomatic and are usually diagnosed
by preoperative evaluation but these appendiculocaecal fistulas are
asymptomatic as in our case and can be diagnosed on interval appendectomy.
The optimum treatment
in these patients consists of appendectomy with bipolar closure of two
appendicular stumps.4 Thorough histopathological examination
of the retrieved specimen of appendix is mandatory to rule out chronic
inflammatory or malignant disease.
- Muthukumarassamy R, Shankar Raman R, Sarath Chandra S, Jagdish S. Appendico-cutaneous fistula.
Indian J Surg 2005;67:323-324.
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Hoffer FA, Ablow RC, Gryboski JD, Seashore JH. Primary Appendicitis with an Appendico-tuboovarian
fistula. AJR 1982;138:742-743
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Kjellman T. Appendiceal
fistula and calculi review of literature and a report of three cases.
Acta Chir Scand 1957;113:123-139
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Bode CO, Odelola MA.
Entero-cutaneous fistula of the vermiform appendix in childhood: case
report. West Afr J Med. 2000;19(2):154-155.
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Byrne DG, McGregor
JR. Aortoappendiceal fistula a case report. J Coll Surg Edin 1992;37(4):25
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Monaghan K, Cogbill TH.
Primary aortoappendiceal fistula: case report and review of the literature.
J Vasc Surg 2002;35(6):1284-1286.
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Ooi CW, Usatoff V.
Aorto-appendiceal fistula presenting with bleeding per rectum.
ANZ J Surg
2004;74(10):913.
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Iwamoto Y, Onishi
T, Suzuki R, Arima K, Sugimura Y. Uretero-appendiceal fistula. Int J
Urol 2008;15:180–181.
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Kawamura YJ, Sugamata Y, Yoshino K, Abo
Y et al. Appendico-ileo-vesical
fistula. J Gastroenterol 1998;33(6):868-871.
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Koak Y, Jeddy
TA,
Giddings AE. Appendico-cutaneous fistula. J R Soc Med 1999;92(12):639–640.
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