Digestive Fistula Research Articles

P1146 Robotic approach to ileocolic Crohn disease surgery: does it increase the risk of intraoperative incidents compared to laparoscopy? Results of a comparative propensity matched multicentre cohort study

Abstract Background The robotic approach has gained interest in oncologic colorectal surgery. In Crohn’s disease (CD) patients presenting with marked mesenteric inflammation and bowel fragility, very little safety data have been reported (1, 2). The lack of haptic feedback and the restricted surgical field are potential disadvantages of the robotic approach that could lead to a higher risk of intraoperative incidents compared to laparoscopy. Methods A total of 259 patients undergoing minimally invasive ileocolic resection (ICR) for CD (66 robotic and 193 laparoscopic) were included in 3 tertiary IBD centers. Intraoperative incidents were defined as unintended gastrointestinal opening and hemorrhage and conversion. Intraoperative and postoperative outcomes of robotic and laparoscopic approaches were compared after propensity-score matching including CD severity. Results After matching, 66 robotic patients were compared to 66 patients who underwent laparoscopic surgery. CD was defined as complex (i.e. abscess, fistula or inflammatory mass) in most patients in the robotic and laparoscopic groups (71% vs 70%, NS). Ileocolic resection was performed as an iterative procedure in a few patients in both groups (7.6% vs 6.1%, NS), and the main indication for surgery was a symptomatic digestive fistula (50% vs 58%, NS). A primary anastomosis was performed in almost all patients (97% vs 92%, NS). No statistically significant difference was observed between the robotic and laparoscopic groups regarding the rates of intraoperative incidents (15% vs 12%, NS), conversion (12% vs 9%, NS), overall morbidity (36% vs 29%, NS), or intraabdominal septic complications (9.1% vs 9.1%, NS). Compared to laparoscopy, robotic surgery was associated with a longer operative time (183 vs 157 minutes, p = 0.009) and a higher rate of intracorporeal anastomosis (48% vs 1.5%, p < 0.001), with specimen extraction through a Pfannenstiel incision (44% vs 1.5%, p < 0.001). Conclusion The robotic approach does not increase the risk of intraoperative incidents compared with laparoscopy and should not be contraindicated for ICR in CD. In contrast, it may reduce the overall impact of surgery by facilitating intracorporeal anastomosis and Pfannenstiel extraction in a young patient population concerned about the cosmetic results of surgery. References (1)Calini, Giacomo et al. “Ileocolic resection for Crohn’s disease: robotic intracorporeal compared to laparoscopic extracorporeal anastomosis.” Journal of robotic surgery vol. 17,5 (2023): 2157-2166. doi:10.1007/s11701-023-01635-6 (2)Abdalla, Solafah et al. "Perioperative outcomes of minimally invasive ileocolic resection for complicated Crohn disease: Results from a referral center retrospective cohort." Surgery vol. 172,2 (2022): 522-529. doi:10.1016/j.surg.2022.01.046

Gastrointestinal Fistulas after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy A 20 Year Retrospective Analysis

The development of digestive fistulas is a common complication following Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

The Association of Isolated Cecal Necrosis Symptoms with Acute Appendicitis: A Case Report

We report a case of isolated cecal necrosis (ICN) associated with acute appendicitis in a geriatric patient in order to underline the didactic, diagnostic and therapeutic interest. This was a 70-year-old widowed female farmer living in a rural area who presented with localized abdominal pain in the right iliac fossa. The diagnosis of acute appendicitis was made. A Mac Burney incision approach revealed ICN and an inflamed appendix. The patient had an ileostomy and a partial cecal necrosectomy with an epiploic patch. A digestive fistula occurred on postoperative Day 60. The patient was transferred to a more technical center where she had a right hemicolectomy with latero-lateral ileocolic anastomosis. The prognosis was poor. The patient died 4 days later in respiratory distress.

Association of polymorphic loci of the GSS gene with the risk of acute biliary pancreatitis

Aim. To investigate the role of single nucleotide polymorphisms (SNPs) rs13041792, rs1801310, and rs6088660 in the GSS gene and environmental factors in the development of acute biliary pancreatitis (ABP) and its complications.Materials and methods. The material for the study was blood samples obtained from 84 patients with ABP and 573 healthy individuals. Both groups were comparable in terms of gender and age. To diagnose ABP, we used the clinical guidelines recommended by the working group of the Russian Society of Surgeons. DNA was isolated by phenol / chloroform extraction. Multiplex genotyping of SNPs was performed by the iPLEX assay on the MALDITOF MassARRAY-4 genetic analyzer. Statistical data processing was performed using Statistica 10 and SNPStats software.Results. We found that insufficient consumption of fresh vegetables and fruits increased the probability of ABP in carriers of genotypes G/A-A/A at rs1801310 in GSS (р = 0.02). The analysis revealed the association of the T allele at rs6088660 with the odds for developing acute pancreatitis (р = 0.007) and digestive fistulas (р = 0.02). A high probability of death was associated with rs1801310 (G/A genotype, р = 0.002) and rs6088660 (C/T genotype, р = 0.01) in the GSS gene.Conclusion. SNPs rs6088660 and rs1801310 in the GSS gene can be used to predict the course of ABP.

Evolution and Prognosis of Digestif Fistulas in Crohn's Disease (CD) Other Than Ano-Perineal Manifestations (APM)

Background and Objectives: Crohn's disease (CD) is a chronic inflammatory disease of the intestine. It can evaluate by the occurrence of intestinal complications in particular fistulas whose management can be medical or surgical. The objective of our work is to specify the evolutionary modalities, as well as the predictive factors of bad prognosis. Patients and Methods: this is a monocentric, descriptive and analytical retrospective study conducted in a hepato gastroenterology department including patients with fistulizing Crohn's disease, outside ano perineal fistulas from 1990 to 2023. Statistical analysis was performed using SPSS22.0 software. Results: Of a total of 960 patients, 38 had fistulizing CD. 65% of our patients were classified as A3 according to the Montreal classification, and 34% as A2. They were 24 women with a sex ratio of 1.71 F/H. The type of fistula was Greco-Greatic in 4 patients (10.5%), Greco-Colic in 5 patients (13%), Entero-Cutaneous in 12 patients (31.5%), Gastro-Colic in 3 patients (7.9%), Interdigestive and Entero-Cutaneous in 10 patients (26%), Interdigestive and Greco-Vesical in 2 patients. All our patients had benefited from a bi-antibiotic therapy, 33 had benefited from surgical resection. Postoperative treatments were based on therapeutic abstention in 5 patients (13.1%), immunosuppressive treatment in 18 patients (47%), anti TNF treatment in 7 patients (18%). The endoscopic recurrence rate 6 months after treatment was 32.5%. In univariate analysis, the factors influencing the evolution of fistulizing crohn's disease were the number of fistulas and age with p values lower than 0.05 (respectively 0.022 and 0.009). Conclusion: Digestive fistulas represent a complication during CD, which pose a problem of medical-surgical management and have an impact on the quality of life of the patients. Our study showed that age (p=0.022) and the number of fistulas (p=0.009) represent the factors influencing the natural history of fistulizing CD.

LES PERITONITES POSTOPERATOIRES DE L’ADULTE : PRISE EN CHARGE DIAGNOSTIQUE ET THÉRAPEUTIQUE DE 19 NOUVEAUX CAS AU CHU DE TREICHVILLE (CÔTE D’IVOIRE).

Summary The aim of this study was to analyze the diagnostic and therapeutic aspects of 19 new cases of postoperative peritonitis. Patients and Method: Our retrospective study, from January 2018 to December 2022, took place in the Digestive and Proctological Surgery Department of the Treichville University Hospital. There were 19 operated patients with a mean age of 39 years (range 21 and 60 years), with a sex ratio of 1.4. Results: The majority of initial surgical indications concerned acute peritonitis (37%) and intestinal obstruction (31.5%). In 13 patients (73.7%), the signs appeared within 10 days. Frequent general and functional signs were spontaneous abdominal pain (n=15, 78.9%); deterioration of general condition and fever in respectively 13 cases (68.4%) and a state of shock (n=11, 57.9%). The main physical signs were represented by induced abdominal pain (100%) and stool passing through the median wound and the drains in 17 cases (89%). The frequent causes noted were anastomotic release (n=7, 37%), iatrogenic digestive fistula (n=6, 31.7%) and release of the appendicular stump (n=2, 10.52%). At reoperation, the digestive stoma was the most performed procedure in 13 cases (68.4%). The evolution was complicated in 16 patients (84.2%). Seven patients died (37%). Conclusion: Post-operative peritonitis remains serious because morbidity and mortality remains high with 37%. Improving the prognosis requires early diagnosis and medico-surgical management. Keywords: Postoperative peritonitis – anastomotic release – digestive fistula

Epidemiological-Clinical and Therapeutic Aspects of Acute Appendicitis at the Reference Health Center of Commune III (C.S.Ref CIII) of the District of Bamako

Objectives: It was to determine the epidemiological-clinical and therapeutic aspects of acute appendicitis at the Reference Health Center of Commune III of the district of Bamako. Methodology: This was a prospective study from January 1 to December 31, 2020 including patients operated for acute appendicitis and confirmed at histology and cases of abscess and appendicular plastron. Results: We collected 60 cases of acute appendicitis. They accounted for 17.29% of surgical indications. The average age of our patients was 25.5 years. The male sex was the most represented at 63% with a sex ratio of 1.72. The Pain in the right iliac fossa was the most represented reason for consultation with 76.7%. It was at the type of bite 70% of the cases. On physical examination the defense of the right iliac fossa was present in 96.7%. Digestive signs were marked by nausea 28.4% (17 patients) and vomiting 25% (15 patients). The digital rectal exam was painful to the right of the Douglas fir in 76.7% of our patients. In biology a complete blood count (CBC) performed in all our patients has objectified hyper leukocytosis in 80% of cases. The reactive protein (CRP) performed in 36 patients was elevated with values between 18 and 46 mg/ml. The imaging performed was an abdominal ultrasound that found a roundel image of the appendix with increased size in 65%. Surgical treatment consisted of classical Mac Burney appendectomy in 54 patients (90%). The gesture performed was an appendectomy in all our patients. All our appendectomy parts were sent for pathological examination. This examination classified the parts as non-specific appendicitis in 60%, phlegmonous appendicitis in 22% and catarrhal appendicitis in 18% of cases. Surgical follow-up was simple in 98.4% (59 patients) and morbidity was marked by digestive fistula in one patient. We recorded one case of death (1.6%). Conclusion: Acute appendicitis remains the most common surgical emergency in commune III of the district of Bamako. It is a pathology that can be found at all ages of life. Its morbidity and mortality are low subject to early diagnosis and management.

Postoperative digestive fistula produced by drainage tube lesions – a series of 7 consecutive cases and a review of the literature

Postoperative digestive fistula produced by drainage tube lesions – a series of 7 consecutive cases and a review of the literature

Exceptional Complication of Abdominal Parietal Surgery: About A Case of Prosthesis Migration in A Hollow Organ

The parietal cure of a hernia or an abdominal eventration by synthetic prosthesis is the treatment of common practice. The disinsertion of the prosthesis with its intra-abdominal migration is a late and rare complication, which can lead to an intestinal obstruction or a digestive fistula, with an increased risk of infection which can threaten the vital prognosis. The symptomatology is nonspecific. Often inaccurate radiological diagnosis due to its rarity and ignorance of this complication.

The outcomes of palliative surgical treatment in a context of rising incidence of gastro intestinal cancers in Burkina Faso, Africa

Background and objectivesDigestive cancers are frequent and of late diagnosis in Africa. Palliative surgery therefore plays an important role. Our objective is to describe its indications, techniques and results in primary digestive cancers. MethodsRetrospective, bicentric, descriptive study of palliative surgery for primary digestive cancer, performed in Ouagadougou over the last twelve years. The results were assessed according to the degree of improvement in the patients' quality of life. We divided the patients into four groups according to the improvement of the quality of life after the operation. The results were considered very satisfactory when the symptoms disappeared completely. They were considered satisfactory when the symptoms decreased in intensity. They were unsatisfactory when the symptoms kept the same intensity. They were considered poor when the symptoms persisted with greater intensity. ResultsSix hundred and thirty-nine palliative digestive cancer surgeries were performed. All patients had clinical symptoms deteriorating their quality of life (56.7%) or even a surgical emergency (43.3%). Biliodigestive diversion, gastroentero-anastomosis and colostomy were the palliative procedures performed respectively in 26.6%, 16.9%, and 34.1%. Complications were noted in 11.7%. These were digestive fistulas in 9 cases, retraction and stomal prolapse in 11 cases. The improvement of the quality of life was very satisfactory in 76%. ConclusionsPalliative surgery is widely practiced in digestive cancers. It improves the quality of life. African surgeons should be aware and well-educated to safely perform surgical palliative procedures.

Appendico-Cutaneous Fistula: Exceptional Complication of Abdominal Drainage

Appendico-cutaneous fistula is a very rare condition. The few cases reported in the literature follow an initial appendicular pathology or an abdominal infectious process including the appendix. We report an exceptional case of appendico-cutaneous fistula as part of a drainage complication of planned abdominal surgery. This was a 6 week old baby who had been operated on for biliary atresia. An abdominal drain was installed at the end of the surgery. Removal of the drain created an orifice centered by a bud. The healing achieved after the use of silver nitrate was short-lived, giving way to spontaneous digestive fistula. Surgical treatment with a perifistulous approach found a normal appendix in the path of the drain with the tip open to the skin. A simple appendectomy gave an excellent result.

Evolutionary profile of pyonephrosis after surgical treatment, about 23 cases

ObjectivesTo describe the evolving profile of pyonephrosis after surgical treatment, identifying their epidemiological, clinical, paraclinical, and therapeutic aspects. Materials and methodsDescriptive retrospective study spread over a period of 5 years (2015–2019) including patients with pyonephrosis in the urology department. Results23 cases of pyonephrosis were collected. The average age of patients was 49 years (27–71 years), with male predominance (69.56%). It was found that the main element of the patient's medical history was urolithiasis (57%). Lower back pain is the main sign found in (96%) of cases, followed by infectious agents found in (42%) and a large kidney (21%). Renal ultrasound allowed us to evoke the diagnosis in 41% of cases and urine CT scan confirmed diagnosis in the majority of cases. The etiology was lithiasis in 78.26% of cases. Cytobacteriological urine examination (CEBU) isolated germs in 15 patients (65.21%) predominance of Escherichia coli in 7 cases (30.43%). The treatment included a nephrectomy preceded by a Subcutaneous nephrovesical bypass in 21 patients. The outcome was reassuring in 70.7% of cases, the main complications were parietal suppuration (30.43%), followed by chronic kidney failure (8.69%), enteroenteric fistula (4.34%), and digestive fistula (4.34%). The mortality was (8.69%). ConclusionPyonephrosis is a condition that is becoming increasingly rare. The reduction of its incidence may be related to recent advances in medical imaging which allow early diagnosis of causative conditions and their treatment.

The clinical characteristics, treatments and prognosis of post-esophagectomy airway fistula: a multicenter cohort study.

BackgroundPost-esophagectomy airway fistula (PEAF) is a serious complication after esophageal cancer resection. At present, the clinical characteristics, treatments and prognosis of PEAF patients remain inconclusive. We aimed to investigate these problems of patients with PEAF through a multi-center retrospective cohort study.MethodsWe included consecutive patients who underwent esophagectomy for esophageal cancer in seven major Chinese esophageal cancer centers from January 2010 to December 2020. Based on the anatomic characteristics of PEAF patients, PEAFs were divided into Union type I (without digestive fistula) and Union type II [respiratory-digestive fistula (RDF)], and subtypes a and b (tracheal or bronchial fistulas), as well as L1 and L2 (same or different level of fistulas). The clinical characteristics, diagnoses, managements, and effects of the various types were retrospectively analyzed.ResultsPEAF occurred in 85 of 26,608 patients (0.32%), including eight females and 77 males. There were 16 patients with type I and 69 with type II. The numbers of healings, non-healings, and deaths at discharge were 45 (52.9%), 20 (23.5%), and 20 (23.5%), respectively. Type Ib was common in type I, and type II L1 was common in type II. The healing rates of surgical, stent, and conservative treatments were 50%, 60%, and 50%, respectively. All type I patients treated with stent implantation were healed at discharge. The healing rates, mortality, and 3-year survival of type II L1 and type II L2 patients were 55.4% and 30.8%, 17.9% and 30.8%, and 34.3% and 15.4%, respectively. The 5-year survival rates of all PEAFs were 21.1%.ConclusionsPEAF is an infrequent and life-threatening complication after esophagectomy. Patients with different types of PEAF often have different inducements. In this study, we found that the healing rates of surgical and conservative treatments were similar, and stent implantation may have the potential to improve efficacy. Type II L2 patients were the most difficult to cure.

Regenerative medicine for digestive fistulae therapy: Benefits, challenges and promises of stem/stromal cells and emergent perspectives via their extracellular vesicles.

Despite current management strategies, digestive fistulae remain extremely debilitating complications associated with significant morbidity and mortality, generating a need to develop innovative therapies in these indications. A number of clinical trials and experimental studies have thus investigated the potential of stem/stromal cells (SCs) or SC-derived extracellular vesicles (EVs) administration for post-surgical and Crohn's-associated fistulae. This review summarizes the physiopathology and current standards-of-care for digestive fistulae, along with relevant evidence from animal and clinical studies regarding SC or EV treatment for post-surgical digestive fistulae. Additionally, existing preclinical models of fistulizing Crohn's disease and results of SC therapy trials in this indication will be presented. The optimal formulation and administration protocol of SC therapy products for gastrointestinal fistula treatment and the challenges for a widespread use of darvadstrocel (Alofisel) in clinical practice will be discussed. Finally, the potential advantages of EV therapy and the obstacles towards their clinical translation will be introduced.

Management of sleeve gastrectomy leakage: case report

Treatment of postoperative gastric fistula complicated by local and systemic infection is difficult and controversial, particularly when treating obese patients with multiple prior surgical procedures. A 41-year-old male patient was transferred to our hospital to be admitted in the Intensive Care Unit with respiratory failure and postoperative sepsis, after being submitted to bariatric surgery. He had been through four subsequent surgical procedures: 1- a laparoscopic sleeve gastrectomy; 2- an exploratory laparotomy for unproven suspected subphrenic abscess; 3- a laparotomy with splenectomy and peritoneal drainage for splenic and peri-splenic abscess; 4-celiotomy and lavage for purulent peritonitis. Due to persistent clinical and analytical deterioration, and suspicion of left subphrenic abscess and digestive fistula, we proceeded to: identification and drainage of the abscess, adhesiolysis, identification of fistula orifice at the cardiac incisure (methylene blue and perioperative endoscopy), placement of a Pezzer tube for directed and controlled fistulization, Shirley’s drain in the subphrenic space for continuous lavage, jejunostomy for enteral nutrition. Under clinical and imaging control (esophageal transit, fistulography and computed tomography with water-soluble contrasts) he was started on a water diet 2 months after and the Shirley’s drain was later removed. Patient was discharged two and a half months after the intervention, maintaing the Pezzer tube and under enteral nutrition by jejunostomy. Oral feeding started in the 3rd postoperative month and jejunostomy and Pezzer probes were removed. Patient was asymptomatic at seven-month postoperative outpatient appointment.

Cystitis Emphysematous on CT

Emphysematous cystitis is a rare form of lower urinary tract infection characterized by the presence of gas in the lumen and/ or bladder wall. The main cause is diabetes, especially in cases of poor balance or bladder neuropathy, but also in cases of immunosuppression. It is secondary to anaerobic glucose metabolism, which leads to the production of CO2. This leads to parietal emphysema by parietal gas dissection, which can spread in severe forms to the peri bladder cellulo-fat space. Not recommended for diagnosis, the abdomen without preparation may find pneumovesia or pelvic hydroaeriosis. Ultrasonography shows parietal bladder air bubbles with shadow cones. The CT scan shows multiple diffuse circumferential air bubbles in the bladder wall without digestive fistula (Figure 1; Figure 2: blues arrows). The germs involved are aerobic and anaerobic, but especially Escherichia Coli and Klebsiella pneumoniae. The prognosis depends on the early diagnosis and antibiotic treatment.

Early post-operative complications in abdominal surgery at the university clinics of Lubumbashi: Frequency, diagnosis and prognosis

Introduction: Postoperative complications in abdominal surgery have a high incidence in developing countries’ hospitals, thus increasing the rate of their morbimortality. The aim of this work was to determine the frequency of early postoperative complications in abdominal surgery, their indications for operation, the types of postoperative complications, and their prognosis at University Clinics of Lubumbashi. Patients and Methods: This is a descriptive cross-sectional observational study with retrospective data collection from January 1, 2018 to December 31, 2019 including all patients operated on in the abdominal surgery department of the University Clinics of Lubumbashi and having presented complications within 30 postoperative days.Results: The frequency of early postoperative complicationsin abdominal surgery was 32.2%. The sex ratio M / F was 2.5 and the mean age was 31.5 ± 0.6. Emergency was the mode of admission in 80% of cases with a mean admission time of 17.2 ± 0.5. In this study, 71.42% of patients were classified ASA III. The mean time to surgical management was 36.5 ± 1.7 hours.Asthenia (62.9%) and abdominal pain (80%) were the most dominant functional signs. Suppuration of the wound (30.5%), abdominal distension (26.6%) and flow of stercoral fluid through the wall (23.8%) were the most dominant physical signs. The antibiogram on wound secretion (19%), imaging combining the chest x-ray (20%), the abdomen without preparation (27.6%) and the abdominal ultrasound (65.7%) are additional examinations which were more practiced. The post-operative complications were grade III in 95.24% of cases (n = 100) according to the Clavien-Dindo classification. The initial indications for surgery were more dominated by acute peritonitis (60%), followed by mechanical intestinal obstruction (16%). The duration of surgery was> 2 hours in 81% of cases and in 58.09% of cases the initial intervention was performed by a specialist. The mean time to resumption of oral feeding was 3.4 ± 0.6 days (Extreme: 12 hours and 192 hours). POC occurred within 5 days of surgery (59.04%).Surgical complications were more dominant (80%), made up of postoperative peritonitis (33.33%), digestive fistulas (19.5%), surgical site infection (16.7%), post-operative intestinal obstruction (13.1%) and evisceration in 6%% of cases. The majority of post-operative complications (52.4%) had undergone relaparotomy, and the outcome was good in 69.5% of cases (n = 73/105), with a mortality rate of 30.4% of cases (n = 32/105). The mean length of hospital stay was 27.4 ± 0.5 days.Conclusion: Postoperative complications are frequent at University Clinics of Lubumbashi and dominated by infection, postoperative peritonitis and digestive fistulas. The implementation of well-coded management algorithms could reduce this incidence.

The Problem of Early Surgical Revisions After Abdominal Surgery, Study About 83 Cases Recorded in Bangui, Central African Republic

Objectives: To describe the characteristic of reoperated patients, the predictive factors of morbidity and mortality as well as the evolution after early reoperations. Materials and method: The study included a retrospective and prospective series. The files of patients reoperated after abdominal surgery from January 2014 to December 2019 at the general surgery department of Sino-Central African Friendship University Hospital in Bangui were analyzed. Results: Out of 1249 patients operated on and hospitalized in the surgical department and, 83 (6.6%) patients were reoperated. They were 53% male subjects. The average age was 38.4 years old. An initial intervention was carried out urgently by unqualified operators (71.1%). Postoperative peritonitis (42.2%) was the main reasons for reoperation. Time to reoperation was 8.4 days on average. The founding during reoperation was anastomotic disunity (39.8%). A bypass stoma (33.7%) associated with washing and drainage of the peritoneal cavity was performed. In 19.2% of cases, patients underwent iterative reoperation. The rate of death was 24%. Predictive factors of poor prognosis were, initial surgery for acute peritonitis, dirty surgery, patient with ASA score II and III, NISS 2 and 3, unqualified operators, iterative reoperations and digestive fistula. Conclusion: Early re-operations occurred after emergency surgery performed by an unqualified surgeon. They dependent on high mortality. To reduce rate of early reoperations and improve the prognosis, qualified surgical personnel are needed. Unqualified surgeons must be regularly retrained in essential surgical care with particular emphasis on respecting the basic principles of emergency surgery.

Spontaneous External Digestive Fistula of Tuberculosis Origin, Medical Treatment: About a Case at the Timbuktu Hospital

In the literature, the management of enterocutaneous fistula of tuberculosis origin is rare. The aim of this work was to report a case of external digestive fistula of tuberculosis origin in a 10-year-old girl in northern Mali in a situation of armed conflict. She was a 10-year-old patient who was admitted to our general surgery ward for external digestive fistula evolving for more than (4) four years, at admission the general. The karnofsky index was at 40%, she could not sit or hold a cup to drink water. A 3 cm enterocutaneous fistula deafened foul-smelling liquid stools, on clinical examination, the conjunctivas were pale, the lips were dry, the eyes were sunk in the eye sockets, the ribs visible from a distance. The paraclinical aspects (Itra-Dermo-Reaction (IDR) to tubercria, anatomopathology) were positive, specifying the place of medical treatment and evolution under medical treatment. Digestive fistula of tuberculosis origin is a rare condition in surgical settings.

Recurrent inguinal abscess revealing chronic appendicitis: A case report and review of the literature

Introduction: Chronic appendicitis is currently defined as a long standing inflammation of the appendix that presents clinically as prolonged (>48 hours) or intermittent abdominal pain. Its diagnosis is often only made after appendectomy and histological analysis of the appendix. This condition may lead to serious consequences as abscess formation. Case Report: We report the case of a 64-year-old patient who had been operated for a recurrent right inguinal hernia on several occasions and had presented for two years an issue of purulent fluid through the open scar. An abdomino-pelvic computed tomography (CT) scan was requested to look for a potential digestive fistula. It showed a heterogeneous thickening of the hernia scar spread over 39 mm, poorly limited, containing calcification with infiltration of fat around. This infiltration was in contact with the distal end of the appendix which was thickened. We concluded to the diagnosis of chronic appendicitis. Conclusion: Chronic appendicitis is a diagnosis characterized by long-standing lower quadrant pain that is associated with histopathologic chronic inflammatory changes. We must evoke this diagnosis in front of any recurrent inguinal abscess.