A Benign Appendiceal-Colonic Fistula, Diagnosed and Managed Laparoscopically: A Case Report
| Autor: | Tomohiro Ishikawa, Mitsuchika Hosoda, Koichi Taguchi, Hiroki Nakamoto, Hiromasa Namba, Ryoichi Yokota, Kenji Yamada |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Pathologic Processes
Male medicine.medical_specialty Fistula Colonic Fistula medicine.medical_treatment Rectosigmoid Colon Rectum Appendix Malignancy Ileostomy Fluorodeoxyglucose F18 medicine Appendectomy Humans Laparoscopy Colectomy Aged medicine.diagnostic_test business.industry Sigmoid colon General Medicine Articles medicine.disease Appendicitis medicine.anatomical_structure Appendiceal Neoplasms Radiology business |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| Popis: | Patient: Male, 76-year-old Final Diagnosis: Appendiceal-colonic fistula Symptoms: None Medication:— Clinical Procedure: Appendectomy • wedge-shaped resection of rectum Specialty: Gastroenterology and Hepatology Objective: Unusual setting of medical care Background: Treatment methods for appendiceal-colonic fistulas differ greatly depending on whether lesions are benign or malignant. If the tumor is malignant, appendectomy with lymph node resection (ileocecal resection or right hemicolectomy) should be performed. There is no consensus on the method of surgery for organs infiltrated by appendiceal cancer. Furthermore, there are no reported laparoscopic cases that could be prevented from over-surgery by laparoscopy examination or rapid intraoperative pathological examination. Case Report: A 76-year-old man presented with positive fecal occult blood. Lower endoscopy revealed a 10-mm tumor in the rectosigmoid colon accompanied by white moss. A biopsy showed inflammatory granulation and no malignancy. Fluorodeoxyglucose-positron emission tomography showed highly increased accumulation at the tip of the appendix, and the standardized uptake value max was 7.3. We suspected a benign lesion rather than appendiceal cancer with infiltration into the rectosigmoid colon; therefore, we performed laparoscopic appendectomy and wedge-shaped resection of the rectum of the sigmoid colon. An intraoperative rapid pathological examination showed no appearance of malignancy; therefore, additional resection was omitted, and an ileostomy was created in the right lower quadrant. A permanent pathological examination showed complicated appendicitis, with no appearance of malignancy. The ileostomy was closed on postoperative day 25, and the patient was discharged on postoperative day 32. Conclusions: In cases where there is difficulty in identifying whether the appendiceal-colonic fistula lesion is benign or malignant, laparoscopy and intraoperative rapid pathological examination may be useful in avoiding excessive treatment. |
| Databáze: | OpenAIRE |
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