Continent appendicovesicostomy in a patient with congenital obstruction of the renal pelvis and multiple kidney transplantations: a detailed case report

Abstract

Congenital obstruction of renal pelvis, also known as ureteropelvic junction (UPJ) obstruction presents as a functional obstruction at the ureteropelvic junction primarily resulting from smooth muscle abnormalities of ureter and pelvis. Appendicovesicostomy commonly known as the Mitrofanoff procedure, is a reconstructive urological surgical technique that utilizes the appendix to create a continent catheterizable channel among the skin and bladder. A 30-year old patient visited the surgical department of Grodno regional clinical hospital with complaints of periodic urine leakage from a fistula in the umbilical region. The condition had been present for a prolonged period with a past medical history of congenital obstruction of renal pelvis and multiple kidney transplantations. Preoperative laboratory investigations revealed mild anemia, with mild decrease in hemoglobin levels, with normal leucocyte and platelet count. A diagnosis of a persistent fistula associated with appendicovesicostomy was established based on these findings from fistulography, CT and cystography. This case report presents a rare persistent umbilical fistula following a continent appendicovesicostomy in a patient with a history of congenital renal pelvis obstruction and multiple kidney transplants.