Appendicovesical fistula: a rare complication of appendicitis

Appendicovesical fistula is an uncommon type of enterovesical fistula and a rare complication of unrecognized appendicitis. Appendicovesical fistula often presents with recurrent or persistent urinary tract infection, especially in men. The commonest causes are appendicitis, cecal diverticulitis, and cystadenocarcinoma or carcinoid tumors of appendix. Approximately 114 cases have been reported previously in the literature, the vast majority in young male patients. Our special case joins the other cases which have already been described in the international literature. This case is a middle-aged man and is the first who has large and multiple fecaliths. We reviewed other cases and contributed an additional one with hope that increased awareness of this entity may facilitate the correct diagnosis and avoid inappropriate management

Reduced bioavailability of oral metronidazole in postoperative ileus

Metronidazole has been reported to reduce postoperative anaerobic infections following surgical procedures. Because of high cost and poor availability of intravenous metronidazole compared with that of oral preparation, we decided to measure the serum level of metronidazole after oral administration in patients during postoperative ileus, and to evaluate the substitution of intravenous metronidazole for the oral product. The present study comprised 45 adult patients undergoing major abdominal surgery via long laparatomy incision from Aug to Nov 2003. [500 mg of Metronidazole was administered as a single dose orally to each patient twice, one in ileus condition and the other in nonileus condition. Blood sampling was done 1 hour after each episode of the drug administration]. A significant reduction [P<0.001] was found between the mean serum metronidazole concentration [2.90 +/- 2.29 SD g/ml] during postoperative ileus, and that of controls [11.07 +/- 6.72 SD g/ml]. In majority of patients [62.5%], the serum level of metronidazole in ileus did not reach its minimum inhibitory concentration [3 micro g/ml] for the most clinically important anaerobic bacteria. Postoperative ileus significantly affected the oral absorption of metronidazole. As a result, if we want to control an active anaerobic infection with a prompt antibiotic therapy, it seems that initiating of the therapeutic regimen with oral Metronidazole postoperatively is not justified