>Cirugía y Cirujanos
>Year 2013, Issue 4
García-Muñoz-Najar A, Carrión-Álvarez L, Medina-García M, García-González MD, Pereira-Pérez F
Appendicovesical fistula treated with elective laparoscopic surgery
Cir Cir 2013; 81 (4)
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Background: appendicovesical fistula is a rare complication
of advanced acute appendicitis and represents a rare type of
enterovesical fistula. Its symptoms are vague and imprecise
and its diagnosis is difficult, requiring a high level of suspicion.
Exploratory laparotomy has been the key for diagnosis and
definitive treatment for many years, but recently the laparoscopic
approach is standing out among different experienced groups as
the method of choice.
Clinical case: we report a new case of appendicovesical fistula
in a 45 year old female, who was remitted from Urology with
symptoms of persistent dysuria and pyuria. She was finally
diagnosed by computerized tomography and the appendicovesical
fistula was resolved by laparoscopic surgery. This case adds to
the one hundred and fifteen cases published so far and to the four
treated by the laparoscopic approach.
Discussion: conventional imaging methods are not reliable for the
diagnosis of enterovesical fistula. Since most appendicovesical
fistula are found to be secondary to non-diagnosed and advanced
acute appendicitis in the majority of the consulted publications
laparotomy is the key for the diagnosis of apendicovesical
fistula. However laparoscopy is described as a diagnostic and
therapeutic tool in few articles. We only found three articles in the
literature referring to the laparoscopic approach as a therapeutic
Conclusion: computerized tomography is the diagnostic
method of choice when communication between the digestive
tract and urinary tract is suspected, particularly if the suspected
fistula is an appendicovesical one. The laparoscopic approach
of an appendicovesical fistula is able to confirm the radiological
diagnosis and provide a definitive treatment.
||colovesical fistula, appendicitis, laparoscopy.
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>Cirugía y Cirujanos
>Year 2013, Issue 4