Table of Contents  
Year : 2015  |  Volume : 8  |  Issue : 1  |  Page : 101-102  

Uretero-appendicular fistula

Department of Surgery, Bharti Medical College and Hospital, Sangli, Maharashtra, India

Date of Web Publication8-Jan-2015

Correspondence Address:
Sunil Magadum
Department of Surgery, Bharti Medical College and Hospital, Sangli-Miraj Road, Sangli - 416 416, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-2870.148867

Rights and Permissions

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

How to cite this URL:
Magadum S, Kurane C, Ingty M, Mulla W. Uretero-appendicular fistula. Med J DY Patil Univ [serial online] 2015 [cited 2023 Sep 22];8:101-2. Available from:

  Introduction Top

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 Top

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 1: Ultrasound picture showing uretero-appendiceal fi stula

Click here to view
Figure 2: The appendix is swollen and severely adherent to the right ureter with uretero-appendiceal fistula (arrow)

Click here to view

  Discussion Top

Ureterocolic fistula is uncommon and uretero-appendiceal fistula are extremely rare. [1] 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. [2] 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. [3],[4] 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. [4] 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. [5] 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. [6] In addition, appendiceal malignancy was considered a possible cause of the fistula [7] . In our case, appendicectomy with segmental ureterectomy and end to end ureteral anastomosis were carried out.

  References Top

Selman SH, Grecos GP. Appendico-ureterocutaneous fistula: report of a case. J Urol 1982;128:593.  Back to cited text no. 1
Yu NC, Raman SS, Patel M, Barbaric Z. Fistulas of the genitourinary tract: a radiologic review. Radiographics 2004;24:1331-52.  Back to cited text no. 2
Nissenkorn I, Hadar H, Servadio C. Uretero-appendiceal fistula, a complication of radical hysterectomy. Br J Urol 1982;54:193.  Back to cited text no. 3
Golimbu M, Morales P, Becker MH. Ureteroappendiceal fistula in child. Urology 1974;3:370-2.  Back to cited text no. 4
Maeda Y, Nakashima S, Misaki T. Ureterocolic fistula secondary to colonic diverticulitis. Int J Urol 1998;5:610-2.  Back to cited text no. 5
Krishna AV, Dhar N, Pletman RJ, Hernandez I. Spontaneous closure of ureterocolic fistula secondary to diverticulitis. J Urol 1977;118:476-7.  Back to cited text no. 6
Iwamoto Y, Onishi T, Suzuki R, Arima K, Sugimura Y. Uretero-appendiceal fistula. Int J Urol 2008;15:180-1.  Back to cited text no. 7


  [Figure 1], [Figure 2]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Case Report
Article Figures

 Article Access Statistics
    PDF Downloaded193    
    Comments [Add]    

Recommend this journal