Appendiculo-Vesical Fistula: A Rare Complication of Acute Appendicitis

Introduction: Appendicovesical fistula is a rare condition that often presents diagnostic challenges. We report the first case managed in our department. Case Report: The patient was a 62-year-old woman who presented with pelvic pain associated with urinary frequency and fever evolving over the past two weeks. Three months earlier, she had experienced pain in the right iliac fossa radiating to the pelvis. No medical investigations were conducted at that time. She had self-medicated, which alleviated the pain. Physical examination was unremarkable except for pelvic tenderness on palpation and pyuria on urination. Laboratory tests revealed leukocytosis with a white blood cell count of 14,000/mm³. A contrast-enhanced abdominal CT scan was performed, revealing a communication between the cecum and the bladder dome. A diagnosis of a cecovesical fistula was made. An exploratory laparotomy was indicated. Intraoperatively, the abdominal cavity was clean. A phlegmonous appendix in the pelvic position adherent to the bladder was discovered. Upon dissection, an orifice communicating the appendiceal lumen with the bladder lumen was identified. An appendectomy was performed along with debridement of the bladder perforation edges and bladder repair (cystorrhaphy) over a transurethral Foley catheter. Conclusion: Appendicovesical fistula is a rare entity. Diagnosis is most often established intraoperatively.