Case Discussions

• 12 Years old girl underwent open appendectomy for appendicular perforation on 25-may-2020.

• She was apparently asymptomatic till June 2020 when she followed up with complaints of opening up of previous incision wound with pus discharge.

• She was treated conservatively with antibiotics according to pus culture sensitivity report .

• Since then her wound hasn’t healed and she is having persistent discharge.

Wound dehiscence in June 2020.

• She was evaluated in December 2020.

• Colonoscopy was done – showed ulceration with nodularity of IC junction , with narrowing ulceration at IC junction. Scope couldn't be passed into terminal ileum.

• Biopsy slides were reviewed here.

• IC biopsy- suggestive of mild active inflammation. Mild cryptitis, no evidence of parasites , granulomas, dysplasias, malignancy.

• Gene Xpert and Rapid TB culture done on colonoscopic biopsy, did not show any M. Tb growth.

• Appendectomy slide review- suggestive of granulomatous appendicitis. No necrosis was seen.

MR enterogram (December 2020)

• Contracted and deformed Cecum with adjacent mural thickening ectending into the terminal ileum.

• Significant luminal narrowing with evidence of enterocutaneous fistula opening into right iliac fossa lateral wall.

• Puckering of the overlying skin suggestive of chronic fistula.

• Few subcentric lymphnodes noted in the RIF.

MR enterogram (December 2020)

• Came to AIG for further evaluation.

• Only symptoms – occasional pain in abdomen on/off, crampy in nature and perisistent discharge from the wound.

• Routine investigations were done.

• Mountoux test done in January 2020 was negative.

• TB quantiferon gold done on January 2020 was negative.

• LFT, RFT, were unremarkable.

• Hb- 11gm/dl , serum iron – 35mcg/dl.

• ESR – 28mm/hr.

• Fecal calprotectin – 75mg/kg.

Present status of wound and discharge.

Summary

• 12 years old girl,

• Status post appendectomy on may 2020,

• Persistent enterocutaneous fistula since June 2020.

• Next plan of management ??