Spontaneous appendico-cutaneous fistula: an unusual presentation of retroperitoneal appendicular perforation associated with psoas abscess

Spontaneous appendico-cutaneous fistula is an extremely rare complication of appendicitis and only a few cases are reported in literature. We present one such case in a 65-year-old diabetic male who had recurrent atypical abdominal pain for 32 years. The patient also had recurrent right psoas abscess, which had failed to respond to a repeated surgical drainage, antibiotics and anti-tubercular treatment. Patient presented to us with recurrent discharging sinus in right lumbar region since 6 months. Multi-detector computed tomography (MDCT) suspected the appendicitis as a possible cause. On laparotomy, retroperitoneal perforated appendix tip was found communicating with the fistulous tract. Appendectomy with excision of fistulous tract resulted in cure. To prevent inappropriate treatment and complication in such atypical presentation of appendicitis, high index of suspicion is required and MDCT is a very useful tool for making correct diagnosis.