Replacement of the left ureter by autograft of the vermiform appendix

Abstract

Case reportsterile. The ureteral catheter was removed by cystoscopy 30 days after A 49-year-old, white woman. who complained of umbilical pain, hac. had a laparotomy at another hospital; a retroperitoneal turnour was found and the biopsy showed the turnour to be a .well-diKerentiated leiomyosarcoma .to the left of the umbilicus, An intravenous pyelogram showed that the left ureter was displaced towards the midline with no evidence of obstruction and there was a calcified stone in the left kidney (Fig. I).At operation on 20 December 1978, the retroperitoneal tumour was the inferior mesenteric vessels and cm of the left ureter which was appendix. which was transected at its base and the tip discarded. The lumen of the appendix was washed with saline solution. The appendix with the appendicular artery was transposed towards the left and an isoperistaltic end-to-end anastomosis was performed to the transected ureter, with 5-0 silk, not including the mucosal layer. A ureteral catheter was placed through the transplanted appendix and its lower tip left loose in the bladder. A Penrose drain was placed near the anastomosis. An intravenous pyelogram performed 15 days after the operation showed a small leak in the superior anastomosis which closed spontaneously (Fig. 2). Urinary cultures repeated after the operation were Operation.The Pathological report revealed. 'tWnoUr of 14 X 10 X 8 cm to which a segment of X cm of ureter was attached'. Microscopic diagnosis was 'leiomyosarcoma which did not invade the ureter'.The subsequent intravenous p y e h r a m s showed a perfect ureteral transit without fistula. We were, however, unable to visualize the lumen of the transplanted appendix but, since no ureteral dilation was seen above the anastomosis, we confirmed that the function of the appendiceal graft was good.two nodular metastases in the right lung and several in both lobes of the resectable liver metastases in both lobes. However, at this time, the function of the left ureter is perfect (Fig. 3).Examination was normal apart from a 10cm removed with the aponeurosis ofthe psoas muscle to which it was fixed, adherent to the tumOUr, The defect was reconstructed using the At present, 40 months after the Operation, the patient has developed laparotomy showed nonliver, demonstrated by CT scan. ~i~~~~~iThe substitution of the ureter by the vermiform appendix has been considered a simple and 'elegant' solution (1). The technique has been described by Melinkoff (21, Kuss (31, Soloviov (4) and Couvelaire (5. 6). The appendix is not always available since appendectomies are frequent but, when present, eter from renal pelvis to hludder. Leak of the superior ureterouppendireal anastotnosis.Postoperative introvenous pyelograpliy with a ureteral cath-

Review of appendiceal onlay flap in the management of complex ureteric strictures in six patients

“…Since that time multiple case reports and small case series have been published on appendiceal interposition [3][4][5][6][7][8][9][10][11][12][13][14][15][16]; however, end-to-end anastomosis carries significant risk of stricture recurrence.…”

Reemplazo ureteral con apéndice cecal

“…El lumen apendicular es irregular y tiene aproximadamente un calibre de 8 Fr de diámetro, tamaño que se asemeja al del lumen ureteral permitiendo una anastomosis segura con uréter distal y proximal. Técnicamente la interposición con apéndice es sencilla y puede ser movilizado a izquierda y derecha sin tensión [6][7][8][9][10][11][12][13] .…”

Appendix vermiformis as a left pyelo-ureteral substitute in a 6-month-old girl with solitary kidney

“…Restricted availability after appendectomy, post-inflammatory changes and fibrosis, missing length and a short mesoappendix may limit the use of the appendix. [8][9][10][11][12][13] General concerns using bowel in reconstructive urology, like recurrent urinary tract infection, tumor formation, In general, vascularity of the AV is excellent, the length of the mesoappendix is rarely a limitation and mobilization of the appendix to the left side is easily performed. It can also satisfactorily used for other substitutions such as an appendicovesicostomy [14] or hepaticoportoappendicostomy [15] and in the majority of cases with satisfactory results.…”