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Case Reports
. 2025 Jul 9;19(1):328.
doi: 10.1186/s13256-025-05382-0.

Acquired appendiceal-cecal fistula as a complication of untreated acute appendicitis in a noncompliant patient: a case report

Mohammad AshrafAzimi  1 , Abbas Abdollahi  2 , Amir Rahmanian Sharifabad  3 , Seyed Hassan Seyed Sharifi  1 , Ali Mehri  2 , Seyed Ramin Dabiri  4   5
Affiliations
Case Reports

Acquired appendiceal-cecal fistula as a complication of untreated acute appendicitis in a noncompliant patient: a case report

Mohammad AshrafAzimi et al. J Med Case Rep. .

Abstract

Background: Appendiceal fistula is a primary appendix perforation into the surrounding hollow viscera or skin and can rarely occur as a complication of appendicitis. To date, only nine cases of appendiceal fistula to the cecum have been reported.

Case presentation: We present the case of a 30-year-old Persian male who presented with a low-grade fever and lower abdominal pain for 3 days. He had a history of untreated acute appendicitis 3 years prior. During the appendectomy, a fistula between the appendix and cecum, along with a thick cecal wall, was found. The patient underwent a right hemicolectomy and was discharged with a diagnosis of appendiceal-cecal fistula in the context of appendicitis.

Conclusion: An appendiceal-cecal fistula usually does not cause any specific symptoms and is an accidental finding. Surgeons should thoroughly explore the ileocecal region for the fistula, particularly in patients with a history of untreated appendicitis. Although the appendiceal-cecal fistula is a rare finding, it can change the surgical plan. Therefore, it is important to discuss this complication with the patient and obtain informed consent preoperatively to avoid potential medicolegal issues. On the basis of our experience, right hemicolectomy is associated with a good surgical outcome in managing the fistula, especially when malignancy is suspected.

Keywords: Appendicitis; Cecum; Complication; Fistula; Hemicolectomy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The author has obtained written informed consent from the patient to participate in the study. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A picture of the fistula’s orifices. (A) Arrow I: fistula’s orifice in the appendix body located 2 cm from the appendix base; arrow II: fistul’s orifice in the cecal wall located 1 cm from the appendix base. Fistula between the appendix and cecum (B)
Fig. 2
Fig. 2
The diagram of the appendix with a fistula to the cecal wall. Arrow I: tinea of the colon; arrow II: the ileum; arrow III: primary appendiceal orifice; arrow IV: fistula between the appendix body and the cecal wall
Fig. 3
Fig. 3
Fistula’s tract in the appendix body (A) and the cecal wall (B) with increased granulation tissue, fibroblasts, and chronic inflammatory cells
See this image and copyright information in PMC

References

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