Management of appendicovesical fistula in children: case report and literature review

Objective To summarize the diagnosis and treatment experiences of pediatric appendicovesical fistula (AVF). Methods The clinical data of two AVF children was analyzed retrospectively between January 2011 and April 2014. And the literature was reviewed between February 1985 and May 2014. The disease onset, clinical manifestations, diagnosis, treatment and prognosis were examined. Results One 9.5-year-old boy was admitted for repeated fever and urinary infection after drainage of abdominal abscess 5 months ago. Ultrasound revealed localized thickening at the bottom of bladder. Another 7.5-year-old boy was hospitalized with gross hematuria, urinary pain and pneamaturia for 1 month. Both underwent operations. The operative findings and postoperative pathological examination supported the diagnosis of AVF. The outcomes were satisfactory at the recent follow-up. Literature review retrieved 11 cases of pediatric AVF. There were 8 boys and 3 girls with an average age of 10.5 (1.0-17.0) years. Ten cases had intermittent urgency, urinary frequency, dysuria and penile pain (including 2 cases of pneamaturia and fecaluria) while another developed intestinal obstruction. These 13 AVF children had a longer course of disease than those of the same age and gender with appendiceal abscess. The postoperative follow-up period was uneventful. Conclusions Pediatric AVF is extremely rare and its preoperative diagnosis remains difficult. A definitive diagnosis is based upon history collecting, physical examination and imaging tests. Laparoscopic surgery is ideal for diagnosing and treating pediatric AVF except for routine exploratory operations. Key words: Appendicovesical fistula; Child; Diagnosis; Treatment protocols