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 lum

Lone, Nazir Ahmad

Rashid, Adil

Rather, Ajaz Ahmad

Salati, Sajad Ahmad

English

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

Sajad Ahmad Salati

Ajaz Ahmad Rather,

Nazir Ahmad Lone,

Adil Rashid,

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Appendicocecal Fistula – A Rare Complication of Appendicitis

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Case Report:
Appendicocecal Fistula – A Rare Complication of Appendicitis
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
Address For Correspondence:
Dr. Sajad Ahmad Salati,
Lane 2, Bulbul Bagh,
Srinagar, Kashmir, India.
E-mail: docsajad@yahoo.co.in
Citation:  Salati SA, Rather AA, Lone NA, Rashid A. Appendicocecal Fistula – A Rare Complication of Appendicitis.  Online J  
Health Allied Scs. 2010;9(4):31
URL: http://www.ojhas.org/issue36/2010-4-31.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Oct 2, 2010; Accepted: Oct 15, 2010; Published: Jan 20, 2011
Abstract:
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
Introduction:
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
Case Report:
A 40 years old man was admitted with complaints of right iliac 
fossa pain with tenderness. There was no other medical or sur-
gical  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.Pa-
tient was managed conservatively on intravenous fluids and in-
travenous antibiotics. The lump regressed and patient was dis-
charged 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.  Ap-
pendectomy was performed and both stumps were closed and 
buried into cecum. Histopathological examination of the speci-
men of appendix ruled out inflammatory bowel disease and ma-
lignancy. The patient made an uneventful recovery.
Fig 1: Horse shoe configuration with clamped cut ends of 
appendix shown with black arrows
Discussion:
Spontaneous appendiculocaecal fistula is a very rare complica-
tion of acute appendicitis.  Various types of fistulae involving 
appendix reported in  literature include appendicoenteric4,  ap-
pendicoaortic5-7,  appendicouterine,  appendicotuboovarian2,  ap-
pendicoureteric8, appendicoileovesical9, appendicovesical9,  and 
appendicocutaneous1,10 fistulae. The mechanism of formation of 
these fistulae has been described by the Kejellman3 as spontan-
eous  rupture  of  inflammed  appendix  into  the  adjacent  bowl, 
bladder or skin. In acute appendicitis the tip is frequently adher-
ent  to  parenchymatous  organs  but  fixation  of  inflamed  ap-
pendix 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 fistu-
las. The appendiculovesicular ,appediculocutaneous and appen-
diculoaortic 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 inter-
val appendectomy. 
The  optimum  treatment  in  these  patients  consists  of 
appendectomy  with  bipolar  closure  of  two  appendicular 
1
This work is licensed under a
Creative Commons Attribution-
No Derivative Works 2.5 India License
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 9, Issue 4; Oct-Dec 2010
stumps.4 Thorough  histopathological  examination  of  the 
retrieved specimen of appendix is mandatory to rule out chronic 
inflammatory or malignant disease. 
References:
1. Muthukumarassamy  R,  Shankar  Raman  R,  Sarath 
Chandra S, Jagdish S. Appendico-cutaneous fistula. 
Indian J Surg 2005;67:323-324.
2. Hoffer FA, Ablow RC, Gryboski JD, Seashore JH. 
Primary Appendicitis with an Appendico-tuboovari-
an fistula. AJR 1982;138:742-743
3. Kjellman T. Appendiceal fistula and calculi review 
of literature and a report of three cases.  Acta Chir  
Scand 1957;113:123-139
4. Bode CO, Odelola MA. Entero-cutaneous fistula of 
the vermiform appendix in childhood:  case report. 
West Afr J Med. 2000;19(2):154-155. 
5. Byrne DG, McGregor JR.  Aortoappendiceal fistula 
a case report. J Coll Surg Edin 1992;37(4):25
6. Monaghan K, Cogbill TH. Primary aortoappendiceal 
fistula:  case report  and review of the literature.  J 
Vasc Surg 2002;35(6):1284-1286.
7. Ooi  CW, Usatoff  V.  Aorto-appendiceal  fistula 
presenting  with  bleeding  per  rectum.  ANZ J  Surg 
 2004;74(10):913.
8. Iwamoto  Y,  Onishi  T,  Suzuki  R,  Arima  K,  Sug-
imura  Y.  Uretero-appendiceal  fistula.  Int  J  Urol 
2008;15:180–181.
9. Kawamura YJ, Sugamata Y, Yoshino K, Abo Y et 
al.  Appendico-ileo-vesical  fistula.  J Gastroenterol 
1998;33(6):868-871.
10. Koak  Y,  Jeddy  TA,  Giddings  AE.  Appendico-cu-
taneous fistula. J R Soc Med 1999;92(12):639–640.
2


Aorto-appendiceal fistula presenting with bleeding per rectum.

Aortoappendiceal fistula a case report.

Appendiceal fistula and calculi review of literature and a report of three cases.

Appendico-cutaneous fistula.

Entero-cutaneous fistula of the vermiform appendix in childhood: case report.

Primary aortoappendiceal fistula: case report and review of the literature.

Primary Appendicitis with an Appendico-tuboovarian fistula.

Uretero-appendiceal fistula.

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Appendicocecal Fistula – A Rare Complication of Appendicitis

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