A Case of Appendicitis Perforativa with a Fecal Stone Complicated by Right Hydronephrosis

A rare case of appendicitis perforativa with a fecal stone complicated by right hydronephrosis is reported. A 25-year-old man visited the Department of Medicine in, our hospital with lower abdominal pain. Computed tomography and intravenous pyelography revealed a stone in the right lower abdomen and right hydronephrosis, and a small-intestine series revealed deformity of the terminal ileum and the cecum. He was referred to the Department of Surgery suspected of a right ureter stone or Crohn's disease. Retrograde pyelography and Ba-enema suggested a diagnosis of right hydronephrosis associated with a fecal stone in the appendix, and surgery was performed. The appendix contained a fecal stone 1.5cm in diameter in the base, which had penetrated to the retroperitoneum in the peripheral side, and the right ureter was constricted by inflammatory granulation. Retrograde appendectomy and separation of the right ureter from granulation were performed. Intravenous pyelography and ultrasonography revealed that hydronephrosis was improved on the 16th postoperative day. We concluded that the right hydronephrosis was caused by stenosis of the right ureter due to granulation induced by perityphlitis which followed perforation of the appendix because of a fecal stone.