POST-APPENDECTOMY FISTULAS OF THE CECUM - A REPORT OF 22 CASES

Appendicitis, usually a benign disease, can have its prognosis worsene d in case of postoperative latter occurs rarely after open appendectom y (0,133 %), but accounts for 10 % of the morbidity rate. The authors reviewed 22 cases of these fistulas, treated during a 24-year period ( January 1970 to December 1993), The aim of these retrospective study w as to precise their clinical features, to evaluate paraclinical examin ations in diagnosing these complications and to give guidelines for th eir treatment. Fistulas occured at day 14 in the postoperative course. In 21 case, appendicitis was severe (suppurative, gangrenous or perfo rated) or appendectomy quoted as technically difficult. Location of th e appendix was atypical in 7 cases. Drainage of the site was performed in 17 cases at the time of appendectomy. Diagnosis was made on the as pect of the drainage fluid in 14 cases. Diagnosis workup of the fistul a associated plain abdominal radiograph and abdominal ultrasonography (n=22). Fistulography (n=6) confirmed the clinical diagnosis of fistul a, showing the leaking in all cases. Medical treatment was attempted f irst in 14 cases and was successfull in 11 cases with a healing time f rom 13 to 72 days. Surgical treatment (open drainage of the site) was attempted first in 11 cases, and was mandatory in 3 other cases becaus e of medical treatment failure : one patient died and 5 patients under went re-operation (right colectomy in 3 cases, bypass in 1 case and re -drainage in 1 case). Fistulography in our experience, is highly relia ble and is considered to be a great assistance in management of these fistulas. Medical treatment remains the best initial treatment modalit y. Surgery must be contemplated in case of etablished external fistula s, and of purulent purulent or faecal fistulas. Nevertheless, prognosi s remains poor (50 % re-operation rate).