Chronic appendiceal perforation leading to cecal–abdominal wall fistula long misdiagnosed as recurrent groin abscess: a rare case report
- 1Department of Gastrointestinal Hernia and Abdominal Wall Surgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- 2Department of Laboratory Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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.
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BibTeX
@article{li2026chronic,
title = {{Chronic appendiceal perforation leading to cecal–abdominal wall fistula long misdiagnosed as recurrent groin abscess: a rare case report}},
author = {Jun Li and Wen-Na Liu and Zheng-Hong Jiang and Hai-Bo Xiong and Li-Bin Deng and Li-Hao Deng},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1901981},
url = {https://doi.org/10.3389/fmed.2026.1901981},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Chronic appendiceal perforation leading to cecal–abdominal wall fistula long misdiagnosed as recurrent groin abscess: a rare case report
AU - Jun Li
AU - Wen-Na Liu
AU - Zheng-Hong Jiang
AU - Hai-Bo Xiong
AU - Li-Bin Deng
AU - Li-Hao Deng
PY - 2026
DA - 2026/10/22
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1901981
UR - https://doi.org/10.3389/fmed.2026.1901981
AB - 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.
SN - 2296-858X
ER -