Vesico-Appendiceal Fistula Misdiagnosed as Meckel's Diverticulum: A Laparoscopic Approach

Abstract

A 26-year-old man complained of a vague low abdominal discomfort for the previous 2 months. Radiologic evaluations demonstrated that there was tubular structure connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a mass-like bladder wall thickening. With an impression of Meckel's diverticulum with fistula with the bladder, laparoscopic surgery was performed to confirm a diagnosis and to manage the Meckel's diverticulum with fistula with the bladder. The distal tip of the appendix was firmly attached to the right side of the bladder. The final diagnosis was corrected by laparoscopy followed by laparoscopic appendectomy and fistula repair. Vesico-appendiceal fistula is an uncommon type of vesico-enteral fistula and a rare complication of unrecognized appendicitis. Additionally, this report showed the significant value of laparoscopy as a diagnostic and therapeutic tool to this entity.

Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula

“…3–5 Although AVF has occurred spontaneously without any disease and comorbidities in our case, it can be revealed after appendicitis.…”

Surprising image of an enterovesical fistula resulting from a perforated Meckel's diverticulitis

“…1,2 Usual complications include bleeding and intestinal obstruction, however intussusception, herniation as well as the Meckel's diverticulum containing neoplastic tissue or ectopic tissue are also reported. 1,4,5 This case report alludes to that a perforated Meckel's diverticulum may mimic several much more common conditions ranging from inflammatory bowel disease to perforated appendicitis, that can affect the approach to treatment greatly. 4,5 In our case, the diagnosis was aided by CT imaging showing the Meckel's diverticulum but not the fistula.…”

“…1,4,5 This case report alludes to that a perforated Meckel's diverticulum may mimic several much more common conditions ranging from inflammatory bowel disease to perforated appendicitis, that can affect the approach to treatment greatly. 4,5 In our case, the diagnosis was aided by CT imaging showing the Meckel's diverticulum but not the fistula. This is in line with the literature showing that CT is usually only of use in complicated cases of Meckel's diverticula.…”

“…Meckel's diverticulum are present in approximately 2% (0.8–4%) of the population with most people remaining asymptomatic for life or rarely presenting with complications which usually arise earlier in life . Usual complications include bleeding and intestinal obstruction, however intussusception, herniation as well as the Meckel's diverticulum containing neoplastic tissue or ectopic tissue are also reported …”

“…Enterovesical fistula secondary to a perforated Meckel's diverticulum is a diagnostic challenge due to its rarity . This can be further complicated as the condition can mimic Crohn's small bowel disease with urinary obstruction …”