Vesico-appendiceal fistula in a mucinous adenocarcinoma of the appendix

Abstract

BACKGOUND: A rare case of vesicoappendiceal fistula secondary to mucinous adenocarcinoma of the appendix is presented. CASE REPORT: A 62-year-old man with a one year history of recurrent urinary tract infections. After two months he developed pneumaturia and fecaluria. An abdominal and pelvic computed tomography demonstrated a trans-mural mass in the posterior wall of the bladder with a vesicoenteric fistula leading to the terminal ileum. Laparotomy revealed a tumor arising from the appendix contiguous with the bladder posterior wall. The bladder was opened and a large fistula and tumor on the posterior bladder wall near the trigone was identified. Frozen pathological analysis showed a mucinous adenocarcinoma. En-bloc right hemicolectomy and partial cystectomy, preserving bladder trigone was performed. After manipulating the tumor, grossly leakage of mucinous materials occurred into the pelvic cavity. A peritoneal washing with a mytomicin solution at 42º C was then performed, to prevent peritoneal seeding. The patient had a prolonged postoperative ileus and was discharged at the 15th day. Five months after the procedure the patient was recieving chemotherapy with 5-fluoracil and leucovorin and there was no signs of recurrent disease. CONCLUSION: The presentation with vesico-appendiceal fistula is extremely rare with only a few cases reported in the literature. Knowledge of different types of neoplasm and appropriate treatment allows the surgeon to provide patients optimal care referring to specialized centers whenever appropriate.

Appendiceal adenocarcinoma masquerading as a primary rectal tumour

“…Such masses can rarely be locally invasive into adjacent pelvic structures, typically the bladder . In the setting of bladder invasion, formation of vesicoappendiceal fistulae has been reported . There is a much smaller literature describing primary appendiceal adenocarcinoma invasive to the rectum at diagnosis, with only one previous reported case .…”

“…[4][5][6] In the setting of bladder invasion, formation of vesicoappendiceal fistulae has been reported. 7,8 There is a much smaller literature describing primary appendiceal adenocarcinoma invasive to the rectum at diagnosis, with only one previous reported case. 9 Recommendations regarding management of appendiceal adenocarcinoma focus primarily on disease confined to the appendix (T3 or less).…”