Spontaneous appendico-renal fistula: clinical presentation and management of a previously unreported entity

Abstract

Entero-urinary fistulas are uncommon in urological practice and may have widely varying aetiologies ranging from benign to malignant or iatrogenic in nature. All permutations of entero-urinary fistulas have been reported in the literature except an appendico-renal fistula. Here, we present one such case, presenting with urinary tract infections and perineal urethrocutaneous fistulae. He was ultimately diagnosed to have a spontaneous appendico-renal fistula as underlying pathology behind the symptoms.

Keywords: urethritis; urinary tract infections; urological surgery; urology.

Figure 1

(A) Retrograde urethrogram showing proximal bulbar urethracutaneous fistula with distal narrowing. (B) Non-contrast CT showing right xanthogranulomatus changes (dashed circle). A thickened inflamed luminal structure (double arrow) with tiny concretions and lying in the vicinity was later identified as appendix on surgical exploration.

Figure 2

(A) Intraoperative image during right nephrectomy through combined extraperitoneal and intraperitoneal flank approach, showing the appendix adherent to renal parenchyma and forming appendico-renal fistula (dotted arrow). A feeding tube could be passed easily into the pelvicalyceal system. The tip of the appendix is cranial (bold arrow) while its base (dashed arrow) has been ligated and separated from the cecum. (B) Specimen demonstrating appendico-renal fistula with a feeding tube going into the pelvicalyceal system through the fistula opening (bold Arrow) and coming out through the laterally opened kidney specimen. Dashed arrow represents the corresponding opening in the mid of appendix.