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Appendicovesical fistula presenting as hypokalaemic hyperchloraemic metabolic acidosis: a case report.

Authors :
Keane S
Tebala GD
Source :
Annals of the Royal College of Surgeons of England [Ann R Coll Surg Engl] 2019 Jul; Vol. 101 (6), pp. e131-e132. Date of Electronic Publication: 2019 Jun 03.
Publication Year :
2019

Abstract

A 52-year-old man was admitted with diarrhoea and faecaluria and referred recurrent urinary tract infections for over 20 years. He also reported a two-week hospital admission more than 20 years ago for right iliac fossa pain, which was managed conservatively. Computed tomography showed a fistulous tract extending from the bladder with an unclear connection to the bowel. Cystoscopy confirmed the presence of a vesical fistula and biopsy of the tract confirmed colonic mucosa. Flexible sigmoidoscopy was negative. A cystogram was requested as an outpatient procedure and the patient was discharged after antibiotic treatment. A few days after discharge the patient was readmitted as an emergency to critical care for severe hyperchloraemic hypokalaemic acidosis and a Glasgow Coma Score of 6/15. He was intubated and ventilated and his metabolic derangement was treated. As soon as his conditions improved, he underwent emergency laparotomy, which revealed the presence of a fistula between the caecal fundus and the bladder. The fistula was repaired and the patient recovered swiftly and completely and was discharged on postoperative day 5. At 12-month follow up the patient was completely symptoms-free, his bowel habits were normal and he has not had any urinary infection. Appendicovesical fistula is a rare and potentially lethal condition due to its metabolic consequences. Past history of right iliac fossa pain treated conservatively, diarrhoea and recurrent urinary tract infection must raise suspicion.

Details

Language :
English
ISSN :
1478-7083
Volume :
101
Issue :
6
Database :
MEDLINE
Journal :
Annals of the Royal College of Surgeons of England
Publication Type :
Academic Journal
Accession number :
31155884
Full Text :
https://doi.org/10.1308/rcsann.2019.0047