Abstract
A 41-year-old male was admitted with chief complaints of melena and an abdominal mass. Four years before, a malignant lymphoma of the right side of the neck was diagnosed, and the tumor responded to chemotherapy.
A barium enema study revealed marked external compression on the sigmoid colon. This compression was attributed to recurrent malignant lymphoma. The patient received VEPA therapy. During the course of VEPA therapy, melena developed again. A repeated barium enema disclosed a fistula between the appendix and the sigmoid colon. A fistulous tract seemed to penetrate the malignant lymphoma mass.
Apperdiceal-intestinal fistulas are very rare. In Japan, only 21 cases have been reported. The causes of this condition in reported cases were mostly appendicitis and cancers of the ileocecal region. The fistulas were detected by barium enema most successfully.
Regarding the mechanism of the formation of appendiceal-intestinal fistula, we speculate that after the appendix is immobilized a weak area tears to form a fistula communicating with the intestine. That is, immobilization of appendix is prerequisite.
The present case is noteworthy, because X-ray films of the area around the appendix were taken both before and after the formation of an appendiceal-sigmoid fistula.
