Fistulae involving the appendix: a systematic review of the literature

Abstract

Background The appendix has a unique place in surgical history. Although the first ever appendicectomy involved a fistula to the skin, fistulae involving the appendix remain uncommon and can lead to unique surgical considerations. Methods A systematic review of the literature was performed for case reports of appendiceal fistulae. We excluded cases in which the patient had a history of appendicectomy. Cases were categorized by site and aetiology, with information regarding relative frequency and demographics obtained. Results A total of 301 case reports of fistula involving the appendix were found. The most common sites of these fistulae were to the bladder (148 cases), skin (40 cases), vasculature (19 cases), umbilicus (16 cases) and to the gastrointestinal tract. The most common aetiology in sub‐analysis was appendicitis alone (150 cases), with less common causes including appendiceal adenocarcinoma (32 cases) and congenital abnormalities (18 cases). There were significantly more appendiceal fistulae in males than in females, with a ratio of 1.7:1. In patients with appendiceal adenocarcinoma as a cause for fistula, there were significantly more females than males with a ratio of 2.3:1. Conclusion In conducting a systematic review of case reports of fistulae involving the appendix, we identified 301 unique case reports, with a range of different sites and aetiologies.

Unusual Manifestation of a Non-inflamed Appendiceal Fistula as a Necrotizing Soft Tissue Infection in the Setting of a Gigantic Ventral Hernia

“…Appendiceal fistulae are an uncommon type of enteric fistulae. They are defined as the primary perforation of the appendix into an adjacent hollow viscus or skin [4]. Appendico-cutaneous fistulae are rare but have been described as complications of appendiceal abscess drainage, incomplete appendectomy, or as spontaneous complications of acute appendicitis.…”

“…Appendico-cutaneous fistulae are rare but have been described as complications of appendiceal abscess drainage, incomplete appendectomy, or as spontaneous complications of acute appendicitis. Acute appendicitis, particularly when associated with a fecalith or an obstructing neoplasm, is the most commonly identified source of appendiceal fistulae in a review by McDonald et al [4].…”

“…Uncommonly, they may be due to enterocutaneous fistula formation after bowel surgery or in other intra-abdominal inflammatory processes. Appendiceal fistulae are the most uncommon type of enteric fistula [3][4]. Specifically, appendico-cutaneous fistulae, though rare, have previously been described in the literature [4].…”

“…Appendiceal fistulae are the most uncommon type of enteric fistula [3][4]. Specifically, appendico-cutaneous fistulae, though rare, have previously been described in the literature [4]. The most common cause of appendiceal fistulae is acute appendicitis [4].…”

“…Specifically, appendico-cutaneous fistulae, though rare, have previously been described in the literature [4]. The most common cause of appendiceal fistulae is acute appendicitis [4]. Although acute appendicitis is typically due to an obstructing fecalith or tumor in adults, it may also occur as a result of incarceration of the appendix within an abdominal wall or inguinal hernia.…”