Combination of CT imaging and endoscopy in diagnosis of appendicovesical fistula caused by appendiceal adenocarcinoma

Abstract

The appendiceal diseases, particularly appendicitis, are the most common disorders in the digestive system localized at the right lower quadrant area. However, appendiceal carcinoma with vesico-appendiceal fistula is a rare clinical phenomenon. Lacking specific symptoms, appendiceal carcinomas with fistula formations are often misdiagnosed as acute appendicitis cases. The purpose of this study is to increase awareness of appendiceal neoplasms and appendicovesical fistulas. We reported our experiences in three complex cases related to digestive and urological systems, and reviewed the literature on diagnosis with various X-ray imaging techniques for this lesion. In this report, the first case failed to be diagnosed. The other two patients with appendicovesical fistulas secondary to appendiceal adenocarcinomas were successfully detected with computed tomography (CT) and cystoscopy. The patients recovered after right hemicolectomies and en bloc partial cystectomies and survived without tumor metastasis up to 7-year follow-up. In conclusion, a combined use of CT imaging and endoscopy techniques provides an accurate diagnostic alternative for appendicovesical fistula secondary to appendiceal adenocarcinoma.

Fistulae involving the appendix: a systematic review of the literature

“…Of the 148 cases of fistula to the bladder, 52 cases had insufficiently detailed case information to be included in our sub‐analysis . Fistulae involving the urinary tract also included those which projected to the kidney (two cases), ureter (four cases), and one case of urachal cyst …”

Fistula Formation Secondary to Mucinous Appendiceal Adenocarcinoma May Be Related to a Favorable Prognosis: A Case Report and Literature Review

“…Our search of a medical literature database showed that only 29 cases of MAA with fistula formation have been reported in the English literature. The clinical characteristics of these previous patients and our own are summarized in Table ( 7 , 8 , 12 - 36 ). The patients were 19 women and 11 men with a median age of 65.5 years (range, 38 to 90).…”

Late stage diagnosis of mucinous adenocarcinoma of the appendix: a case report of an unusual tumor with a rare presentation

“…Appendiceal mucoceles are more common in women (4:1) and therefore may be misdiagnosed as gynecological pathologies such as a cystic right adnexal mass of the ovary or fallopian tube [5,6]. MAA may also be mistaken for a urinary tract infection or bladder cancer as it can present with hematuria in both men and women [7][8][9][10][11][12][13][14][15][16]. In rare cases, MAAs present as scrotal pain due to metastasis and may even been found within de Garengeot hernias [17,18], which are femoral hernias containing the appendix.…”