A Case of an Appendico-vesical Fistula due to Appendicitis Detected by Gross Hematuria

Abstract

The patient was a 55-year-old man with a history of appendicitis that resolved with conservative treatment. One year later, he visited the urology department with a complaint of gross hematuria and was referred to our department. Cystoscopy showed a fistula at the outer side of the right ureteral opening, and abdominal magnetic resonance imaging showed a cystic lesion in the bladder wall, with the ileum in contact with the bladder. Based on the above, an appendico-vesical fistula due to appendicitis or a malignant tumor of the appendix was diagnosed, and laparoscopic ileo-cecal resection (D3 dissection) with partial cystectomy jointly with the urology department was performed. Since the urology department was scheduled to perform a partial cystectomy through a small laparotomy, the oral and anal intestinal tracts were separated in the abdominal cavity, a small laparotomy wound was made in the midline of the lower abdomen, the bladder wall was resected in the area of adhesion, and the specimen was removed from the small laparotomy wound. Pathological examination showed no malignant findings. An appendico-vesical fistula is a rare form of intestinal vesical fistula, and it is very difficult to determine whether it is benign or malignant preoperatively. This is the third case of an appendico-vesical fistula treated by laparoscope assisted surgery in Japan, and it is reported with a review of the literature.