Appendiceal intussusception with appendiceal–caecal fistula in adults caused by acute appendicitis: case report and literature review

Abstract

Intussusception is the telescoping of the proximal segment of bowel into the adjacent distal segment, primarily seen in children but rare in adults. 1 However, intussusception of appendix is more common in adults (76%) than children (24%) as well as being more common in females (78%) compared to males (28%), with the most common pathology being inflammation followed by endometriosis. 2 Although it only accounts for up to 5% of bowel obstructions in adults, 90% of cases are due to underlying intestinal pathology ranging from polyps to neoplasms. 1 Unlike infants, adults exhibit non-specific symptoms including colicky pain, nausea, bowel changes and gastrointestinal bleeding. 3,4 Surgical resection remains the mainstay treatment in most cases of adult intussusception due to high risk of malignancy. 5 We present a case of appendiceal intussusception with appendicealcaecal fistula caused by an acute appendicitis treated with laparoscopic-assisted limited ileocolic resection.A 50-year-old female presented with colicky right lower quadrant abdominal pain that she reported began 3 days prior associated with nausea but otherwise denied vomiting or abdominal distension. She had no significant past medical history other than three previous caesarean sections.She was afebrile and her other vital signs were normal. Abdominal examination revealed a focal tenderness over the right iliac fossa with no other signs of peritonism. Laboratory testing was largely unremarkable except for an elevated C-reactive protein of 60 mg/L. Computed tomography (CT) of the abdomen with intravenous contrast revealed findings suspicious for an appendiceal intussusception (Figs 1,2). A thickened dilated appendix up to 12 mm was seen arising from the caecal junction forming the lead point.