A Case of Low-grade Appendiceal Mucinous Neoplasm Associated with Enterocutaneous Fistula Arisen from the Remnant Appendix 17 Years after Appendectomy

Abstract

A 69-year-old man undergone appendectomy 17 years earlier was referred to our hospital because of recurrent episodes of infection of the surgical wound. A contrast-enhanced abdominal CT scan revealed fluid retention in the abdominal cavity just under the surgical wound. Fistulography showed the ileum with enhancement, so that he was diagnosed with enterocutaneous fistula and was operated on. Since the fistula had adhered to the surgical stump of the appendix and the ileum, partial resection of the cecal end and the ileum was performed. The histopathological diagnosis was low-grade appendiceal mucinous neoplasm (LAMN).

LAMNs are clinically malignant tumors which can cause pseudomyxoma peritonei. LAMNs arisen from the residual appendix, especially those presented with enterocutaneous fistula like in this case, are very rare. When we encounter fistulation from the surgical stump of the appendix, we should carefully perform surgical treatment by keeping a possibility of an appendiceal tumor in mind.