World J Mens Health.  2012 Dec;30(3):195-197.

Vesico-Appendiceal Fistula Misdiagnosed as Meckel's Diverticulum: A Laparoscopic Approach

• Lee JW
• Ahn JH
• Ha HK

Abstract

A 26-year-old man complained of a vague low abdominal discomfort for the previous 2 months. Radiologic evaluations demonstrated that there was tubular structure connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a mass-like bladder wall thickening. With an impression of Meckel's diverticulum with fistula with the bladder, laparoscopic surgery was performed to confirm a diagnosis and to manage the Meckel's diverticulum with fistula with the bladder. The distal tip of the appendix was firmly attached to the right side of the bladder. The final diagnosis was corrected by laparoscopy followed by laparoscopic appendectomy and fistula repair. Vesico-appendiceal fistula is an uncommon type of vesico-enteral fistula and a rare complication of unrecognized appendicitis. Additionally, this report showed the significant value of laparoscopy as a diagnostic and therapeutic tool to this entity.

Keyword

Appendicitis; Urinary bladder; Fistula; Laparoscopy

MeSH Terms

Appendectomy
Appendicitis
Appendix
Fistula
Laparoscopy
Meckel Diverticulum
Urinary Bladder

Figure

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  Fig. 1 Cystoscopy showed bullous erythematous changes of the dome of the urinary bladder. However, there was no definite fistulous tract opening or stool debridement in the bladder.

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  Fig. 2 Computed tomography scan demonstrates enhanced mass-like mucosal thickening at the right side of the bladder (white arrow).

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  Fig. 3 Intraoperative laparoscopic findings show a long appendix, which is firmly attached to the right side of the urinary bladder dome (white arrow). B: bladder, C: cecum.

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