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.
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。