PDF(Pubmed)
Abstract：
BACKGROUND: Appendiculocolonic fistulas, often arising from benign conditions like abscess-forming appendicitis, manifest subtly. This case emphasizes their rarity, intraoperative discovery during acute appendicitis, and explores diagnostic intricacies, sensitive imaging, and distinctions in managing benign versus malignant cases.
METHODS: A 23-year-old intellectually disabled patient, lacking regular medical follow-up and surgical history, presented to our emergency department with persistent right iliac fossa pain six months ago. Due to financial constraints, a CT scan was not performed despite an inflammatory syndrome, and the patient left against medical advice. Currently experiencing the same symptoms, investigations led to the diagnosis of acute appendicitis with a probable appendico-sigmoid fistula. Surgical exploration confirmed the appendico-sigmoid fistula and the presence of an uncomplicated Meckel\'s diverticulum. A conservative approach, including appendectomy, Meckel\'s diverticulum resection, and sigmoid fistula suturing, yielded favorable results.
UNASSIGNED: Appendiculocolonic fistulas often arise from acute or chronic appendicitis with local abscess formation. Our case highlights the unusual progression of untreated acute appendicitis, evolving into an appendico-sigmoid fistula. While generally benign, documented cases of malignant causes, such as appendiceal cancer, exist. Diagnosis is intricate, requiring diverse methods, with abdominal CT as a sensitive imaging tool. Conservative approaches are generally recommended for benign cases.
CONCLUSIONS: Appendiculocolonic fistulas, though rare, pose a clinical challenge due to their elusive symptoms. Primarily associated with benign conditions, notably abscess-forming appendicitis, or, as in our case, untreated acute appendicitis. This case underscores the role of abdominal CT in precise diagnosis, guiding treatment decisions based on the lesion\'s nature.
METHODS: A 23-year-old intellectually disabled patient, lacking regular medical follow-up and surgical history, presented to our emergency department with persistent right iliac fossa pain six months ago. Due to financial constraints, a CT scan was not performed despite an inflammatory syndrome, and the patient left against medical advice. Currently experiencing the same symptoms, investigations led to the diagnosis of acute appendicitis with a probable appendico-sigmoid fistula. Surgical exploration confirmed the appendico-sigmoid fistula and the presence of an uncomplicated Meckel\'s diverticulum. A conservative approach, including appendectomy, Meckel\'s diverticulum resection, and sigmoid fistula suturing, yielded favorable results.
UNASSIGNED: Appendiculocolonic fistulas often arise from acute or chronic appendicitis with local abscess formation. Our case highlights the unusual progression of untreated acute appendicitis, evolving into an appendico-sigmoid fistula. While generally benign, documented cases of malignant causes, such as appendiceal cancer, exist. Diagnosis is intricate, requiring diverse methods, with abdominal CT as a sensitive imaging tool. Conservative approaches are generally recommended for benign cases.
CONCLUSIONS: Appendiculocolonic fistulas, though rare, pose a clinical challenge due to their elusive symptoms. Primarily associated with benign conditions, notably abscess-forming appendicitis, or, as in our case, untreated acute appendicitis. This case underscores the role of abdominal CT in precise diagnosis, guiding treatment decisions based on the lesion\'s nature.
摘要：
背景：阑尾结肠瘘，通常是由脓肿形成的阑尾炎等良性疾病引起的，微妙的表现。这个案例强调了他们的稀有性，术中发现急性阑尾炎，探索诊断的复杂性，敏感成像,以及处理良性和恶性病例的区别。
方法：一名23岁的智障患者，缺乏定期的医疗随访和手术史，六个月前右髂窝持续疼痛被送到急诊科.由于资金紧张,尽管有炎症综合征，但没有进行CT扫描，病人不顾医生的建议离开了。目前正在经历同样的症状，研究结果诊断为急性阑尾炎伴可能的阑尾乙状结肠瘘。手术探查证实阑尾乙状结肠瘘和无并发症的Meckel憩室存在。保守的方法，包括阑尾切除术,Meckel憩室切除术,乙状结肠瘘缝合,产生了良好的结果。
■阑尾结肠瘘通常由急性或慢性阑尾炎伴局部脓肿形成引起。我们的病例突出了未经治疗的急性阑尾炎的异常进展，演变为阑尾乙状结肠瘘.虽然通常是良性的，记录在案的恶性原因，比如阑尾癌，存在。诊断很复杂,需要不同的方法，以腹部CT作为敏感的成像工具。对于良性病例，通常建议采用保守方法。
结论：阑尾直肠瘘，虽然罕见，由于其难以捉摸的症状，构成了临床挑战。主要与良性疾病有关，尤其是脓肿形成的阑尾炎，或者，就像我们的情况一样，未经治疗的急性阑尾炎。此病例强调了腹部CT在精确诊断中的作用，根据病变的性质指导治疗决策。
方法：一名23岁的智障患者，缺乏定期的医疗随访和手术史，六个月前右髂窝持续疼痛被送到急诊科.由于资金紧张,尽管有炎症综合征，但没有进行CT扫描，病人不顾医生的建议离开了。目前正在经历同样的症状，研究结果诊断为急性阑尾炎伴可能的阑尾乙状结肠瘘。手术探查证实阑尾乙状结肠瘘和无并发症的Meckel憩室存在。保守的方法，包括阑尾切除术,Meckel憩室切除术,乙状结肠瘘缝合,产生了良好的结果。
■阑尾结肠瘘通常由急性或慢性阑尾炎伴局部脓肿形成引起。我们的病例突出了未经治疗的急性阑尾炎的异常进展，演变为阑尾乙状结肠瘘.虽然通常是良性的，记录在案的恶性原因，比如阑尾癌，存在。诊断很复杂,需要不同的方法，以腹部CT作为敏感的成像工具。对于良性病例，通常建议采用保守方法。
结论：阑尾直肠瘘，虽然罕见，由于其难以捉摸的症状，构成了临床挑战。主要与良性疾病有关，尤其是脓肿形成的阑尾炎，或者，就像我们的情况一样，未经治疗的急性阑尾炎。此病例强调了腹部CT在精确诊断中的作用，根据病变的性质指导治疗决策。
