Trauma has been reported as a cause of appendicitis on several cases in the literature. The present study reports the relationship between blunt abdominal trauma (BAT) of injury severity score less than 4 and appendicitis. A 17-year-old girl developed appendicitis after a minor BAT. An ecchymosis at the right lower quadrant misled the diagnosis, which was made 1 day later. Laparotomy revealed an inflamed appendix, a few enlarged mesenteric lymph nodes, contusion, as well as punctuated bleeding sites of the caecum. Moreover, based on a brief literature review, the different pathophysiological mechanisms and the difficulties of diagnosis of this entity are discussed. It is suggested that appendicitis should be considered as a possibility in the setting of right lower quadrant pain following minor BAT, when there is clinical suspicion of an inflammatory process within the right iliac fossa.

Objective Two conventional approaches for vesicovaginal fistula (VVF) repair are transabdominal repair for supratrigonal VVF and transvaginal approach for low lying fistulae. Laparoscopic surgery was introduced to duplicate the surgical steps of the transabdominal approach with reduction in morbidity. We report a series of patients treated with a modified laparoscopic technique which includes the use of only three trocars and a limited posterior cystotomy. Methods We retrospectively reviewed the data of eight patients who underwent laparoscopic VVF repair with our standardized technique from January 2015 to April 2018. Only cases with a supratrigonal fistula were included. We constantly used only three trocars. A limited 2 cm midline posterior cystotomy was performed using ultrasonic energy. A stay suture on a straight needle was passed percutaneously in the abdomen, then on either side of the cystotomy and finally was exteriorized to maintain countertraction. The cystotomy was extended downwards to include the fistula site. The fistula was dissected circumferentially to raise the bladder and vaginal flaps. The vaginal defect was closed in a transverse fashion and the cystotomy was closed vertically. Results Mean operative time was 178±31.6 min and estimated blood loss was 60±18.7 mL. Flap interposition was performed in six cases. No intraoperative complications were recorded. Mean hospital stay was 2.25±0.89 days. During hospitalization two patients experienced postoperative complications (Clavien grade I). Mean follow-up was 20.9±11.1 months (6.0–39.0 months). All patients remained continent during the follow-up period. Conclusions This minimally invasive laparoscopic approach with only three trocars and limited posterior cystotomy provides excellent results with minimum morbidity.