A case of acute appendicitis penetrating to sigmoid colon

Abstract

We report a case of acute appendicitis with penetration to the sigmoid colon. The patient was a 76-year-old male who came to our hospital with the complaints of right flank pain and fever of 37°C. A hard tender mass was palpable at right lower quadrant of the abdomen without signs of peritoneal irritation. Blood test showed significant sign of inflammation and an abdominal CT revealed a mass of 8cm in size in the right lower abdomen consisting of conglomeration of the ileum and ascending colon. An intraabdominal abscess caused by acute appendicitis was suspected and antibiotics were administered resulting in significant improvement of the symptoms. Emergent operation was not performed, After the conservative management, an endoscopic study was done which revealed an elevated lesion with a spot of depression in the sigmoid colon 20cm orally from the anus. Lower intestinal image study revealed a lineal communication between the appendix and the elevated lesion of the sigmoid colon. A diagnosis of acute appendicitis with penetration to the sigmoid colon was made and a laparotomy was performed 2 months later. At the laparotomy it was found that a part of the appendix was adhered to the sigmoid colon in fascicular fashion forming a fistula, The presence of malignancy was not suspected and simple appendectomy and division of the fascicular adhesion was done.