Acute Appendicitis Post Ureteroneocystostomy for Uretero-Vaginal Fistula: A Rare Diagnostic Dilemma.

Abstract

Introduction: Ureterovaginal fistula is a common complication of hysterectomy which is treated by uretero-neocystostomy after appropriate investigation. This is rarely complicated by acute appendicitis post-operatively. Case report: We report 39-year-old woman who developed intermittent colicky right flank pain third day post- ureteroneocystomy for ureterovaginal fistula. There was tenderness in the lower abdominal quadrants and guarding. She had abdominal re-exploration, appendectomy and drainage of pelvic abscess. The post-operative period was uneventful and she was discharge home 10 days post operatively. Conclusion: Acute appendicitis may mimic post- operative urological complication. High index of suspicion and judicious use of clinical features are required to make prompt decision for re-exploration and appendicectomy. Routine exploration of appendix in pelvic surgeries may mitigate against missing these cases. This may prevent the diagnostic dilemma, morbidity and mortality.