A Case of Appendiceal-Sigmoid Fistula

Hirofumi Suwa, Nobuo Baba, Kouichi Demura, Takashi Imamura, Shunichi Ishigami, Jun Tamura, Mitsuaki Koumoto, Hiroki Ogawa, Tatsuyoshi Saiga and Shiro Sakanashi

Department of Surgery and Department of Pathology, Otsu Red Cross Hospital

A 64-year-old man presenting with lower abdominial pain and fever was referred to our hospital. A barium enema examination showed an irregular shaped wall and extravasation of barium of the sigmoid colon. Computed tomography showed a high density area coincident with the extravasated barium near the sigmoid colon and ileoceacal region, but no tumorous lesion was noted. The abdominal pain and fever improved after one and a half months of conservative therapy. Open laparotomy was subsequently performed, because a malignant disease could not be ruled out. Severe inflammatory changes were found in the appendix, of which the distal end adhered to the sigmoid colon. En bloc resection of the appendix and sigmoid colon was performed, and a fine fistula was found between them. Histopathological examination confirmed severe inflammatory changes in the appendix and that appendiceal-sigmoid fistula had been caused by appendicitis. In cases of appendiceal-sigmoid fistula, careful observation or low-invasive treatment such as laparoscopic surgery should be also considered in the future.

Key words
appendix, sigmoid colon, fistula

Reprint requests
Hirofumi Suwa Department of Surgery Otsu Red Cross Hospital 1-1-35 Nagara, Otsu, 520-8511 JAPAN

Accepted
October 31, 2001

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