陳昭安¹、林威宇¹、黃文詩²、陳志榕²、許家禎³、黃國財¹、邱國雄¹、楊紫馨¹、徐淑華¹、張殷綸¹、林健煇¹、黃雲慶¹、何東儒¹、陳志碩¹

嘉義長庚醫院外科部泌尿外科¹，大腸直腸外科²

；嘉義陽明醫院泌尿外科³

 

Chao-An Chen¹, Wei-Yu Lin¹, Wen-Shih Huang² ,Chih-Jung Chen², Jia-Jen Shiu³, Kuo-Cai Huang¹ , Kuo-Hsiung Chiu1¹, Tzu-Hsin Yang¹,Shu-Hua Hsu¹, Yin-Lun Chang¹,Jian-Hui Lin¹, Yung-Chin Huang¹, Dong-Ru Ho¹, Chih-Shou Chen¹

¹Division of Urology, ²Division of colon and rectal surgery, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan

³Division of Urology, Yang-Ming Hospital, Chiayi, Taiwan

 

Appendicovesical fistula(AVF) is a rare cause of urinary tract infection. It has been reported that it usually took at least 1 year from the onset of symptom to confirmatory diagnosis. We report a case of recurrent urinary tract infection with delayed diagnosis of Appendicovesical fistula and was treated with single port laparoscopic appendectomy.

A 85-year-old male patient is a case of pancreatic tail mass s/p distal partial pancreatectomy with splenectomy and spine surgery in July, 2015 with and urinary retention and Foley indwelling since then. He had repeat hospital admission for urinary tract infection in recent 20 years and has suffered from fecaluria via Foley catheter for more than 7 months. Low GI series cystoscopy showed non-specific findings. Computed tomography (CT) of the abdomen and pelvis revealed vesico-colonic fistula in Sep, 2015. He was referred to our hospital for surgical intervention. We performed single port  laparoscopic transabdomen approach for diagnosis. Pelvis appendix with tip adesion to bladder dome and pelvis side wall was visualized. We carried out appendectomy with Endo-GIA (ECR-45G) and  excision of fistula between bladder and appendix. No more recurrent UTI occurred postoperatively.

Appendicovesical fistula is difficult in early diagnosis for patient with intractable recurrent urinary tract infection. Diagnosis and surgical intervention by single pole laparoscopy is feasible.