Diarrhea Concealing a Duodenal-Cecal Fistula Secondary to Appendiceal Mucinous Neoplasm
Su Aung1, Amanda Cheung2, Charlene Prather2
1Department of Internal Medicine/Pediatrics, Brown University Alpert Medical School, Providence, RI.
Abstract:
Primary mucinous adenocarcinoma of the appendix is a rare gastrointestinal malignancy. Fistulous tract formation is a complication that is cited in literature. An 85-year-old man with multiple comorbidities presented with several weeks of persistent non-bloody diarrhea. Laboratory work-up was non-diagnostic. Abdominal imaging with barium contrast showed an enterocolonic fistulous tract extending from the duodenum to the cecum involving an enlarged appendiceal mass. Subsequent biopsy confirmed mucinous appendiceal neoplasm with peritoneal spread to the liver and mesentery. This is the first report describing an enterocolonic fistula formation resulting from this malignancy.
Insights
Primary appendiceal mucinous adenocarcinoma, a rare cancer, can cause complications like fistulas. This case highlights an unusual enterocolonic fistula formation from this malignancy in an elderly patient.
Area of Science:
- Gastroenterology
- Oncology
- Surgical Pathology
Background:
- Primary appendiceal mucinous adenocarcinoma is an exceptionally rare gastrointestinal malignancy.
- Fistulous tract formation is a known, albeit infrequent, complication of gastrointestinal malignancies.
Observation:
- An 85-year-old male patient with significant comorbidities presented with prolonged non-bloody diarrhea.
- Initial laboratory results were inconclusive.
- Abdominal imaging revealed an enterocolonic fistula from the duodenum to the cecum, associated with an enlarged appendiceal mass.
Findings:
- Biopsy confirmed the appendiceal mass as a mucinous neoplasm.
- The malignancy had metastasized to the liver and mesentery.
- This represents the first documented instance of an enterocolonic fistula arising from primary appendiceal mucinous adenocarcinoma.
Implications:
- This case expands the known spectrum of complications associated with appendiceal mucinous adenocarcinoma.
- Highlights the importance of advanced imaging in diagnosing rare gastrointestinal pathologies.
- Suggests a need for increased awareness of fistula formation in appendiceal neoplasms.
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