Uretero-Appendicular Fistula with Complete Proximal Ureteric Stricture: A Rare Case Report

Abstract

Uretero appendicular fistula is a very rare finding. It is seen in cases of ureteric injury or in retrocaecal appendicitis or appendicular rupture. In this case, following rectopexy patient complained of right sided abdominal pain, either due to undetected ureteric injury during surgery or post operative appendicitis and rupture causing retroperitoneal or periappendiceal collection and inflammation which in turn compressed the right ureter which gradually caused stricture formation and later ureteroappendicular fistula. This was identified only after attempted insertion of DJ stent in order to reduce the hydroureteronephrosis when DJ stent went through fistula into the appendix due to proximal complete stricture. This case was managed by initial ureteroscopy followed by diagnostic laparoscopy which later got converted to open mini laparotomy with excision of fistula and appendicectomy from base of appendix and ureteric stricture resection and end to end anastomosis. Post operatively DJ stent was insitu for 1 month which helped to resolution of hydroureteronephrosis. Postoperative 6 month followup CTurography scans showed no signs of  ureteric stricture or hydronephrosis or urine leak in abdomen. This case outlines ureteric and appendicular injury as a potential complication of abdominal surgeries as such as rectopexy and the minimally invasive approach to its management.