Appendico-Sigmoid Fistula as a Rare Complication of Chronic or Recurrent Appendicitis: A Case Report.
Shashi Kush, Suvendu Sekhar Jena, Amitabh Yadav et al.
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Case in brief
A 46-year-old woman presented with worsening lower abdominal pain and vomiting over three months. Initial imaging suggested sigmoid diverticular perforation, but repeat contrast-enhanced CT with rectal contrast revealed an appendico-sigmoid fistula. Surgical exploration confirmed the fistula, leading to sigmoid colectomy and appendectomy. The patient had an uneventful recovery and ileostomy reversal after two months.
What made this case unusual
The case highlights the diagnostic challenge of distinguishing an appendico-sigmoid fistula from sigmoid diverticular perforation, particularly due to nonspecific imaging findings.
Diagnostic / clinical pearl
Clinicians should consider appendico-sigmoid fistula in patients with chronic appendicitis presenting with abdominal pain and atypical imaging findings.
Why it matters
This case underscores the importance of careful imaging interpretation, particularly the use of rectal contrast in CT, to accurately diagnose rare complications of appendicitis.