Work

Chronic appendiceal perforation leading to cecal–abdominal wall fistula long misdiagnosed as recurrent groin abscess: a rare case report

Year: 2026

Type: article

Abstract: Background: Chronic appendiceal perforation is extremely rare in adults, and secondary cecal-abdominal wall fistula is even more scarcely reported in the literature. We present a 64-year-old man with a 20 + year history after retroperitoneal abscess drainage and 10 + years of recurrent right groin abscess, ultimately diagnosed as chronic appendiceal perforation with cecal-abdominal wall fistula. Case presentation: The patient underwent open retroperitoneal abscess drainage more than 20 years ago. Subsequently, he developed recurrent right groin pain, erythema, swelling, and fever, repeatedly diagnosed as right iliac fossa abscess requiring multiple incisional drainages, but the condition persisted. Contrast-enhanced abdominal CT and sinography (iohexol) showed a thickened appendix with ill-defined borders from the right psoas muscle, psoas abscess, a tubular structure extending to the right inguinal subcutaneous tissue, and hyperdense contents in the cecum and appendiceal lumen. Preoperative diagnoses: appendiceal perforation and cecal-abdominal wall fistula. Laparoscopic right hemicolectomy, intra-abdominal abscess drainage, abdominal wall sinus tract excision, and adhesiolysis were performed. Intraoperatively, the appendiceal base, body, and adjacent cecum were retroperitoneal, forming a 3.5 × 3.0 cm abscess with a palpable tract to the right inguinal defect. Pathology showed chronic and acute inflammation of the intestinal mucosa with serosal fibrous proliferation, consistent with a cecal fistula. Postoperative paralytic ileus resolved with conservative management. Long-term follow-up revealed no recurrence. Conclusion: Chronic appendiceal perforation is a rare cause of cecal-abdominal wall fistula, which can present as recurrent groin abscess for years. Clinicians should be aware of this entity. Contrast-enhanced CT combined with sinography aids preoperative diagnosis, and complete surgical resection is curative.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1901981

Authors: Jun Li, Wen-Na Liu, Zheng-Hong Jiang, Hai-Bo Xiong, Li-Bin Deng, Li-Hao Deng

Institutions: Chengdu University, University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital

Language: English

Topic: Appendicitis Diagnosis and Management

Subfield: Emergency Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801