A rare case report of an appendico-sigmoid fistula complicating untreated acute appendicitis: Unraveling complexity in diagnosis and treatment.
Int J Surg Case Rep
; 116: 109298, 2024 Mar.
Article
en En
| MEDLINE
| ID: mdl-38342027
ABSTRACT
INTRODUCTION:
Appendiculocolonic fistulas, often arising from benign conditions like abscess-forming appendicitis, manifest subtly. This case emphasizes their rarity, intraoperative discovery during acute appendicitis, and explores diagnostic intricacies, sensitive imaging, and distinctions in managing benign versus malignant cases. CASE PRESENTATION A 23-year-old intellectually disabled patient, lacking regular medical follow-up and surgical history, presented to our emergency department with persistent right iliac fossa pain six months ago. Due to financial constraints, a CT scan was not performed despite an inflammatory syndrome, and the patient left against medical advice. Currently experiencing the same symptoms, investigations led to the diagnosis of acute appendicitis with a probable appendico-sigmoid fistula. Surgical exploration confirmed the appendico-sigmoid fistula and the presence of an uncomplicated Meckel's diverticulum. A conservative approach, including appendectomy, Meckel's diverticulum resection, and sigmoid fistula suturing, yielded favorable results. CLINICALDISCUSSION:
Appendiculocolonic fistulas often arise from acute or chronic appendicitis with local abscess formation. Our case highlights the unusual progression of untreated acute appendicitis, evolving into an appendico-sigmoid fistula. While generally benign, documented cases of malignant causes, such as appendiceal cancer, exist. Diagnosis is intricate, requiring diverse methods, with abdominal CT as a sensitive imaging tool. Conservative approaches are generally recommended for benign cases.CONCLUSION:
Appendiculocolonic fistulas, though rare, pose a clinical challenge due to their elusive symptoms. Primarily associated with benign conditions, notably abscess-forming appendicitis, or, as in our case, untreated acute appendicitis. This case underscores the role of abdominal CT in precise diagnosis, guiding treatment decisions based on the lesion's nature.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Diagnostic_studies
/
Prognostic_studies
Idioma:
En
Revista:
Int J Surg Case Rep
Año:
2024
Tipo del documento:
Article