ACUTE APPENDICITIS COMPLICATED BY ENTEROCUTANEOUS FISTULA IN A YOUNG PATIENT: CASE REPORT

Case Presentation A 25-year-old female patient, overweight, presented to the emergency department with complaints of abdominal pain in the right iliac fossa that had persisted for seven days, accompanied by hyporexia, nausea, and vomiting. Abdominal computed tomography (CT) revealed acute appendicitis with signs of perforation. A conventional appendectomy was performed, noting perforation of the middle third of the cecal appendix. During hospitalization in the surgical ward postoperatively, the patient developed abdominal distension, nausea, vomiting, and purulent/enteric discharge from the surgical wound. A follow-up abdominal CT scan showed gas pockets within the subcutaneous tissue, anterior abdominal muscles, and adjacent to the cecum near the surgical scar, indicating an enterocutaneous fistula. A conservative approach was adopted, involving bowel rest (nil per os) and total parenteral nutrition for nutritional support. The patient responded well to the treatment and was discharged with instructions.

Discussion The appendix is a small organ located at the initial portion of the large intestine. When its lumen becomes obstructed, it leads to an inflammatory and infectious process. Appendicitis is a common condition in surgical practice and is the leading cause of acute abdomen. Postoperative complications are well-documented, and the development of an enterocutaneous fistula is a rare occurrence, affecting approximately 2% of cases following appendectomy. An enterocutaneous fistula is defined as a communication between two epithelialized surfaces. Risk factors include appendix neoplasia, leakage from the appendiceal stump, intestinal infections, distal obstruction, and inflammatory bowel disease. Mortality rates range from 3% to 30%, with sepsis being a critical determinant of outcome.

Conclusion Enterocutaneous fistula is a rare complication associated with surgical procedures, occurring in about 2% of cases after appendectomy. Mortality rates vary, with sepsis being a significant factor influencing mortality.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025