Appendico-colic fistula complicating appendicitis in cystic fibrosis

Abstract

The case of a boy with cystic fibrosis who presented with an unusual complication of appendicitis is reported. Delayed presentation, with complications of appendicitis such as perforation and abscess formation, is not uncommon in cystic fibrosis; however, this case represents the first report of an isolated appendico-colic fistula following appendicitis in association with cystic fibrosis.

Fistulae involving the appendix: a systematic review of the literature

“…83 The fistulae to vascular structures comprised 14 to the aorta 10,[90][91][92][93][94][95][96][97][98][99][100][101][102] and five to the iliac artery. [103][104][105][106][107] Appendiceal fistulae to the GI tract included 10 cases to the sigmoid colon alone, [108][109][110][111][112][113][114][115][116][117] with an additional two concurrently fistulating to the bladder. 118,119 There were 21 cases of fistula to the ileum, 84,[120][121][122][123][124][125][126][127][128] two to the jejunum, 84,129 six to the duodenum, 84,[130][131][132]…”

“…A congenital communication between the appendix and the caecum is termed a 'horseshoe appendix', in contradistinction to an acquired fistula. 161 Cases of fistula to the sigmoid, [108][109][110][111][112][113][114][115][116][117][118][119] ascending colon, 48,139,140 transverse colon 141 and rectum 142 are encountered with a frequency that is roughly concordant with their anatomical proximity to the appendix.…”

“…Although the incidence of appendicitis is actually lower in patients with cystic fibrosis than in the general population, it is more likely to present late with abscess, as the antibiotics taken for lung disease often mask the early stages of appendicitis. 113 Two cases of patients with Hirschsprung's disease and appendiceal fistula have been reported. It has been proposed that Hirschsprung's disease may predispose to appendiceal perforation and subsequent fistula formation.…”

Appendicorectal fistula with a novel solution: First case report and review of the literature

“…Other risk factors for appendiceal fistula include persistent or recurrent urinary tract infection; previous abdominal surgery; a chronic draining cutaneous sinus or an abscess requiring repeat incision; and drainage. There is also a notable population in patients with cystic fibrosis …”

“…There is also a notable population in patients with cystic fibrosis. 34,[41][42][43][44] Optimal surgical treatment of appendiceal fistula will of course be determined by the underlying pathology and structures involved. In our case, the investigation of a suspected case of proctalgia fugax led to the discovery of an appendicorectal fistula by colonoscopy and MRI, which may have been the sequelae of an episode of acute appendicitis on a long pelvic-oriented appendix years earlier.…”