|Year : 2015 | Volume
| Issue : 1 | Page : 101-102
Sunil Magadum, Chandrahas Kurane, Moses Ingty, Wassim Mulla
Department of Surgery, Bharti Medical College and Hospital, Sangli, Maharashtra, India
|Date of Web Publication||8-Jan-2015|
Department of Surgery, Bharti Medical College and Hospital, Sangli-Miraj Road, Sangli - 416 416, Maharashtra
Source of Support: None, Conflict of Interest: None
We present a case of uretero-appendicular ﬁstula. A 30-year-old woman with fever and lower abdominal pain since 3 months was being investigated. Ultrasound abdomen showed appendicitis with connection between appendix and ureter. Appendicectomy with segmental ureterectomy and end to end ureteral anastomosis was carried out.
Keywords: Appendicitis, uretero-appendicular ﬁstula, uretero-enteric fistula
|How to cite this article:|
Magadum S, Kurane C, Ingty M, Mulla W. Uretero-appendicular fistula. Med J DY Patil Univ 2015;8:101-2
| Introduction|| |
Uretero-intestinal ﬁstulae are rare, and uretero-appendicular ﬁstulae are extremely rare. We report a case of uretero-appendicular ﬁstula secondary to chronic appendicitis, which was treated by appendicectomy with segmental ureterectomy and end to end anastomosis.
| Case Report|| |
A 30-year-old multiparous woman presented with multiple episodes of high fever and right side lower abdominal pain since last 3 months. She also gave history of pyuria since last 15 days. Clinical examination revealed tenderness and guarding in right iliac fossa. Laboratory investigations were unremarkable except elevated white blood cell count. Ultrasound of abdomen and pelvis showed turgid appendix with uretero-appendicular fistula and ureteritis [Figure 1]. Both kidneys were normal in size, shape and there was no hydronephrosis. Abdominal exploration was planned through right paramedian incision. Preoperative right retrograde pyelography confirmed uretero-appendicular fistula. A double 'J'stent was placed in right ureter anticipating difficult ureteric dissection. A turgid, inflamed appendix was identified in pelvic position adherent to retroperitoneal content. After adhesiolysis with sharp dissection body of appendix was seen densely attached to middle one-third of right ureter. With further dissection fistulous communication between appendix and ureter was seen [Figure 2]. Appendicectomy was carried out. Segmental ureterectomy with end to end stented anastomosis was done after ureteral spatulation. Postoperative course was uneventful. Histopathological examination revealed inﬂammatory changes in ureter and appendix with obstructing fecalith. There was no evidence of tuberculosis or malignancy.
|Figure 2: The appendix is swollen and severely adherent to the right ureter with uretero-appendiceal fistula (arrow)|
Click here to view
| Discussion|| |
Ureterocolic fistula is uncommon and uretero-appendiceal ﬁstula are extremely rare.  Fistulae can involve the duodenum, jejunum, ileum, and colon. They can be caused by urinary calculi, iatrogenic trauma, radiation therapy, diverticulitis, transitional cell carcinoma, appendicitis, and tuberculosis.  The most likely mechanism for developing a ﬁstula in our case is the occurrence of appendicitis due to fecalith, followed by perforation, abscess formation, and erosion into the ureter. The patients with ureteroenteric fistula usually presents with flank pain, hematuria, recurrent urinary tract infections, fecaluria, pneumaturia, and diarrhea. Direct communication between the appendix and ureter was seen at the time of surgical exploration. , The diagnostic study depends on the anatomic site of origin and termination of the fistula. Antegrade or retrograde urography is useful in making the diagnosis, showing contrast medium entering the cecum, as is barium enema, showing barium entering the ureter.  In our case, abdominal ultrasound revealed uretero-appendicular fistula. In cases of ureterocolic ﬁstula with nonfunctioning kidney nephrectomy with excision and closure of the ﬁstula should be recommended. If the kidney is normal, removal of the ﬁstulous tract and reanastomosis of the ureter should be considered.  It has also been reported that adequate drainage and antibiotic therapy led to spontaneous closure of a ureterocolic ﬁstula secondary to diverticulitis, and radical resection was not recommended in the acute stage.  In addition, appendiceal malignancy was considered a possible cause of the ﬁstula  . In our case, appendicectomy with segmental ureterectomy and end to end ureteral anastomosis were carried out.
| References|| |
Selman SH, Grecos GP. Appendico-ureterocutaneous fistula: report of a case. J Urol 1982;128:593.
Yu NC, Raman SS, Patel M, Barbaric Z. Fistulas of the genitourinary tract: a radiologic review. Radiographics 2004;24:1331-52.
Nissenkorn I, Hadar H, Servadio C. Uretero-appendiceal fistula, a complication of radical hysterectomy. Br J Urol 1982;54:193.
Golimbu M, Morales P, Becker MH. Ureteroappendiceal fistula in child. Urology 1974;3:370-2.
Maeda Y, Nakashima S, Misaki T. Ureterocolic fistula secondary to colonic diverticulitis. Int J Urol 1998;5:610-2.
Krishna AV, Dhar N, Pletman RJ, Hernandez I. Spontaneous closure of ureterocolic fistula secondary to diverticulitis. J Urol 1977;118:476-7.
Iwamoto Y, Onishi T, Suzuki R, Arima K, Sugimura Y. Uretero-appendiceal fistula. Int J Urol 2008;15:180-1.
[Figure 1], [Figure 2]