To the Editor.—In a recent issue of the Archives, an article on enteric fistulas of appendiceal origin was published. In this article the authors state that the existence of a calculus producing this entity could not be substantiated in any of the case reports that were reviewed.
I have recently cared for a case which seems to demonstrate that this can occur.
A 65-year-old man complained of colicky abdominal pain for three weeks, extending over the whole lower abdomen. Barium enema revealed a constricting lesion of the sigmoid colon. At laparotomy, in addition to a definite neoplastic lesion of the lower sigmoid, a matted mass of bowel was found adherent to the sigmoid mesentery. On dissection the mass consisted of a loop of mid jejunum adherent to the appendix.
These structures were resected along with the sigmoid. The lesion in the sigmoid colon was reported as adenocarcinoma. The bowel