A Case of Mucinous Cystadenocarcinoma of the Vermiform Appendix with Vesical and Colonic Fistula

Sumitomo Kato, Hitoya Kobayashi, Tsukasa Nakagawa

Department of Surgery, Yukokai General Hospital

A case of carcinoma of the vermiform appendix forming a colonic and vesical fistula is presented along with a review of the literature previously reported in Japan. A 48-year-old woman was admitted to our hospital because of abdominal distension with pain. Colonoscopy revealed a fistula in the sigmoid colon and a tumor at the orifice of the appendix. A CT scan of the abdomen disclosed a distended appendix filled with high density substance, suggesting the accumulation of mucus. On exploration, a distended, thickened, enlarged tumor of the vermiform appendix that invaded to the sigmoid colon and urinary bladder with peritoneal dissemination was found. Ileocecal resection and removal of the colonic and vesical fistula were performed. Gross examination of the specimen revealed a distended vermiform appendix, inside which was a mucinous tumor connecting to the sigmoid colon and urinary bladder through the fistula. Histological evaluation revealed mucinous cystadenocarcinoma. Review of the 15 cases with fistula formation reported in the Japanese literature indicated that the histological type was mostly mucinous cystadenocarcinoma. Fistula formation was presumably due to the biological behavior of mucinous cancer, which was likely to invade outward. Although fistula formation in appendiceal cancer in itself may imply a more advanced stage and result in poorer prognosis, 4 of 15 reviewed resections were evaluated as curative, suggesting that an extirpative procedure with curative intent should be attempted for invasion to the adjacent organ or metastatics lymph nodes in the management of carcinoma of the appendix with fistula.

Key words
cystadenocarcinoma of the vermiform appendix, vesical fistula, colonic fistula

Reprint requests
Sumitomo Kato Department of Surgery, Yukokai General Hospital
1-34-1 Shimizu, Ibaraki City, 567 JAPAN

Accepted
September 8, 1993

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