Partial substitution of the right ureter with the vermiform appendix

Abstract

A 53-year-old woman with obesity, hypertension, insulindependent diabetes mellitus and ischaemic vascular disease of lower extremities represented too great a risk for a more invasive procedure than chemical lumbar sympathectomy with 96% ethanol. The procedure was carried out in the department of vascular surgery. Six days later she was admitted for nausea and vomiting; IVU showed a right-sided retroperitoneal urinoma. The urinoma was drained and the ureter stented. After a month the stent was removed, but hydronephrosis with flank pain followed. The patient then had urosepsis. With a nephrostomy inserted, she was referred for final treatment. From a right flank incision the remnants of obliterated ureteric segment were excised; the retrocaecal appendix was deemed to be a good fit to bridge the gap of 7 cm. To prevent twisting of the mesum, the tip of the appendix had to be anastomosed onto the proximal ureteric end, leaving the base for anastomosis with the distal ureteric end. Both appendiceal ends were spatulated and sutured onto the ureteric ends over a 7 F stent ( Fig. 1) with 4/0 polyglactin. The patient had a 5-day urinary leak through the drain, but then healed. IVU (Fig. 2) and DMSA scintigraphy at 5 and 10 months showed a steadily improving renal function (Fig. 3).