Laparoscopic ileocecal resection can be applied for appendiceal cancer with an ileal fistula: A case report

Abstract

Introduction: Primary appendiceal cancer with fistula formation is extremely rare. We report a case of a patient with appendiceal cancer invading the ileum who underwent successful laparoscopic ileocecal resection.

Presentation of case: A 76-year-old man who presented with fever and abdominal pain was diagnosed with acute appendicitis and received antibiotics at a local hospital. After a few days, he was referred to our hospital because of an abnormality found in the colonoscopy, which was an oozing ulcer in the terminal ileum. Laparoscopic ileocecal resection was performed with a preoperative diagnosis of ileal cancer. The tumor adhered to the right internal inguinal ring. We dissected the right spermatic cord involved in the tumor. The resected specimen revealed a fistula between the appendiceal orifice and ileac ulcer. Histopathological examination revealed a well differentiated tubular adenocarcinoma. We made the diagnosis of appendiceal cancer with an ileal fistula because the ileal ulcer was derived from the appendiceal site.

Discussion: Most cases of appendiceal cancer with a fistula undergo laparotomy, but in selected cases, laparoscopic resection should be considered a feasible, safe, and curative procedure. Our patient underwent laparoscopic ileocecal resection, whereby the tumor and other organs with invasion were resected successfully with a negative surgical margin.

Conclusion: This is the first case report of appendiceal cancer with an ileal fistula successfully treated with laparoscopic resection. Laparoscopic ileocecal resection can be applied for appendiceal cancers with a fistula by experienced surgeons with careful consideration.

Keywords: Appendiceal cancer; Case report; Fistula; Laparoscopic surgery.

Fig. 1

Colonoscopic view of an ulcer that oozed upon slight contact in the terminal ileum.

Fig. 2

Fluoroscopic study of 5-cm narrowing at the small intestine.

Fig. 3

Enhanced abdominal computed tomography scan. A. 45 mm × 55 mm irregular ileocecal wall thickness with enhancement. B. Low density mass such as an abscess caudal of the tumor.

Fig. 4

Surgical findings. A. A tumor surrounded by fatty tissue and omentum was located in the ileocecal area, and an adhesion was formed between the right internal inguinal ring. B. Right spermatic cord was dissected because it was involved in the tumor (arrow: right spermatic cord).

Fig. 5

Resected specimen revealed a fistula between the appendiceal orifice and ileac ulcer. (yellow arrow, appendiceal orifice; red arrow: ileac ulcer).

Fig. 6

Histopathological examination revealed well differentiated tubular adenocarcinoma (hematoxylin and eosin). Tumoral tissue was revealed in the mucosal membrane of the appendix but not in the iliac ulcer. Iliac ulcer was derived from the appendiceal site.