Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3241
Peer-review started: October 10, 2021
First decision: December 12, 2021
Revised: December 30, 2021
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 6, 2022
Appendico-vesicocolonic fistulas and appendiceal-colonic fistulas are two kinds of intestinal and bladder diseases that are rarely seen in the clinic. To our knowledge, no more than 4 cases of appendico-vesicocolonic fistulas have been publicly reported throughout the world, and no more than 100 cases of appendiceal-colonic fistulas have been reported. Although the overall incidence is low, an early diagnosis is difficult due to their atypical initial symptoms, but these diseases still require our attention.
Here, we report a case of a 77-year-old male patient diagnosed with an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula. The main manifestations were diarrhea and urine that contained fecal material. The diagnosis was confirmed by multiple laboratory and imaging examinations. A routine urinalysis showed red blood cells and white blood cells. Abdominal and pelvic computed tomography scans showed close adhesions between the bowels and the bladder, and fistulas could be seen. Colonoscopy and cystoscopy and some other imaging examinations clearly showed fistulas. The preoperative diagnoses were a colovesical fistula and an appendiceal-colonic fistula. The fistulas were repaired by laparoscopic surgical treatment. The diseased bowel and part of the bladder wall were removed, followed by a protective ileostomy. The postoperative diagnosis was an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula, and the pathology suggested inflammatory changes. The patient recovered well after surgery, and all his symptoms resolved.
The final diagnosis in this case was a double fistula consisting of an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula.
Core Tip: Appendico-vesicocolonic fistulas and appendicovesical fistulas are rare diseases involving the intestine and urinary bladder. These conditions have a very low morbidity even in patients with appendicitis after conservative treatment or with malignant tumors. Early symptoms and signs are usually atypical, making early diagnosis and treatment more difficult. Here, we present a case of an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula and provide some recommendations for diagnosis and treatment along with a review of the literature.