Arshad Zafar.
Spontaneous Appendico-Cutaneous Fistula.
J Coll Physicians Surg Pak Nov ;11(9):581-3.

A healthy female aged 16 years presented with a discharging sinus in the right iliac fossa since the last eight months. There was no past history of pain in the right iliac fossa or any other disease. She had consulted several doctors for this disease. Once scrapping of the sinus tract was done by a gynaecologist. On examination, there was a small sinus in the right iliac fossa surrounded by granulation tissue. There was a discharge of thin yellowish-brown pus on pressing the surrounding area. Her hemoglobin was 11 gm%, TLC 6,800 mm3, ESR 7 mm. Blood urea 36 mg/dl, random blood sugar 130 mg/dl. Culture of pus showed E. coli sensitive to amikacin.

Abdominal ultrasound and Chest X-rays were normal. Barium enema was also normal. Fistulogram showed the fistula tract leading from skin to the ileo-caecal region.

Laparotomy was done through an oblique, elliptical incision in the right iliac fossa including the fistula opening. It was found that the fistula tract was appendix itself with its tip adhered to the anterior abdominal wall. No other intra-abdominal pathologies were found. Appendicectomy and primary closure of the abdomen was done.

Appendix and the cutaneous fistula margins were sent for histopathology that showed chronic non-specific inflammation. The patient was discharged for home on seventh postoperative day after removal of skin stitches. At six months follow-up, the patient is doing well.

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