Rare finding of a gastrojejuno appendicular fistula during a laparotomy for roux-en-y conversion

Abstract

Gastrojejuno appendicular fistula is a rare condition. To our knowledge it has not been reported previously in the literature. We report the first case of a gastrojejuno appendicular fistula occurring in a patient who had previous gastroenterostomy for ulcer disease. He presented to us with recurrent episodes of abdominal pain and bilious vomiting. An endoscopy revealed intense gastritis with bile reflux. He was diagnosed as alkaline gastritis and put on medication. As there was no relief of his symptoms; it was decided to do a biliary diversion. At laparotomy there were extensive adhesions which was gently separated. Patient had an anticolic anastomosis and a long tubular structure was seen fistulating to the stoma site. It was traced and found to be the appendix. The gastrojejunal stoma was opened and the fistulous mouth was identified and cannulated following, which a retrograde appendicectomy was performed and a cuff of intestine around the fistula was excised. The Stoma was closed in a single layer. A Braun's enteroenterostomy was done to correct the alkaline reflux. The patient is symptomatically better and is gaining weight. The pathogenesis of alkaline gastritis. appendicular fistula and gastrojejunocolic fistula is discussed.

Fistulae involving the appendix: a systematic review of the literature

“…118,119 There were 21 cases of fistula to the ileum, 84,[120][121][122][123][124][125][126][127][128] two to the jejunum, 84,129 six to the duodenum, 84,[130][131][132][133] eight to the caecum, 84,[133][134][135][136][137][138] three to the ascending colon, 48,139,140 one to the transverse colon, 141 one to the rectum, 142 and one to a gastrojejunal anastomosis from prior gastroenterostomy. 143 In three cases, fistulae involved Meckel's diverticula. [144][145][146] There were 12 cases of fistula to female genital organs including the uterus (five cases), [147][148][149][150][151] fallopian tube (four cases), [152][153][154][155] and vagina (three cases).…”

“…Appendiceal fistulae to the GI tract included 10 cases to the sigmoid colon alone, with an additional two concurrently fistulating to the bladder . There were 21 cases of fistula to the ileum, two to the jejunum, six to the duodenum, eight to the caecum, three to the ascending colon, one to the transverse colon, one to the rectum, and one to a gastrojejunal anastomosis from prior gastroenterostomy . In three cases, fistulae involved Meckel's diverticula …”