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Spontaneous appendico-cutaneous fistula: an unusual presentation of retroperitoneal appendicular perforation

Mahendra Pratap Singh1, Atul Samaiya2, Tarun Kumar Sainia3

  • 1Faculty, Department of Surgery, L.N. Medical College, Bhopal, Madhya Pradesh, India drmpsingh2012@gmail.com.

Journal of Surgical Case Reports
|June 25, 2016
PubMed

Insights

Spontaneous appendico-cutaneous fistula is a rare appendicitis complication. Early diagnosis with multi-detector computed tomography (MDCT) is crucial for effective treatment of atypical presentations.

Area of Science:

  • Gastroenterology
  • Surgical Pathology

Background:

  • Spontaneous appendico-cutaneous fistula is an exceedingly rare complication of appendicitis.
  • Few cases have been documented in medical literature.

Observation:

  • A 65-year-old diabetic male presented with a 32-year history of atypical abdominal pain and recurrent right psoas abscesses.
  • The patient had a 6-month history of a discharging sinus in the right lumbar region, unresponsive to previous treatments.
  • Multi-detector computed tomography (MDCT) suggested appendicitis as the underlying cause.

Findings:

  • Laparotomy revealed a retroperitoneal perforated appendix tip communicating with the fistulous tract.
  • Appendectomy combined with excision of the fistulous tract successfully treated the condition.

Implications:

  • A high index of suspicion is necessary for diagnosing atypical appendicitis presentations.
  • MDCT is an invaluable tool for accurate diagnosis in such cases.
  • Prompt and correct diagnosis can prevent prolonged morbidity and inappropriate treatments.

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