Appendicovesical Fistula

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Foreign bodies are considered to be an infrequent cause of appendicitis, especially in America, where the fæcalith is not regarded as a foreign body. A survey of the literature (Mitchell,1 Fowler2 and Berger3) shows that approximately 2 to 3 per cent of all cases of appendicitis are caused by true foreign bodies. Mahoney4 reports a series of seventy-four cases in which foreign bodies were the cause of appendicitis. In forty of these cases the appendicitis was due to the presence of sharp instruments (pins), and the mortality in thirty-eight was 55.2 per cent. In the majority of these cases the appendicitis occurred in childhood, and no history of swallowing the pin could be obtained.

Keen5 reports the case of a man aged twenty-four, who had suffered from dysuria since the age of seven years. At the onset of the dysuria the family doctor found a pin in the urethra and removed it. The patient stated that he did not insert the pin into the penis, nor did he remember swallowing it. At the age of twenty-three he was thought to have a rectovesical fistula secondary to the rupture of a prostatic abscess. Two unsuccessful attempts were made to close this fistula. One year later a laparotomy was performed and a long appendix was found, with its distal end incorporated into the bladder wall. The appendix was separated from the bladder and removed, and the patient made an uneventful recovery.

Case History

The patient, a man aged twenty-six years, entered the. . .