Delayed diagnosis of appendicovesical fistula following orchidectomy for testicular abscess: a case report

Abstract

Appendicovesical fistula (AVF) is a rare subtype of enterovesical fistula that most commonly develops as a complication of chronic or recurrent appendicitis. Owing to the predominance of urinary rather than gastrointestinal symptoms, diagnosis is frequently delayed, resulting in recurrent infections, repeated investigations, and unnecessary interventions. A 31-year-old man presented with recurrent urinary tract infections (UTIs) complicated by a testicular abscess requiring orchidectomy. Histopathological examination demonstrated non-specific chronic active inflammation. Previous cystoscopy identified a small posterior bladder opening, which was managed as a bladder diverticulum, while colonoscopy was unremarkable. Persistent urinary symptoms prompted referral to the colorectal team, and computed tomography urography suggested an enterovesical fistula. Exploratory laparotomy demonstrated the appendiceal tip adherent to the bladder dome with a calcified faecolith within the appendiceal lumen. Appendicectomy with partial cystectomy was performed. Histopathological examination confirmed a benign AVF. The patient recovered uneventfully with complete resolution of urinary symptoms. AVF should be considered in patients with recurrent or persistent UTIs when conventional urological investigations are inconclusive. Early recognition with contrast-enhanced computed tomography (CT) and timely definitive surgical management can prevent prolonged morbidity and achieve excellent clinical outcomes.