Post-Appendicitis Concerns: Bubbles in Urine After Peritonitis Surgery

Q: Post-Appendicitis Concerns: Bubbles in Urine After Peritonitis Surgery

Hello： The appendix is located in the lower right quadrant of the abdominal cavity. <br>If it becomes inflamed and ruptures, pus can flow down to the lowest part of the abdominal cavity, which is the pelvis. <br>This is a completely reasonable process and can lead to the formatio

Bubbles in urine after peritonitis?

I apologize for bothering you again, Director Ke.
Initially, I had appendicitis which progressed to peritonitis, requiring an emergency surgery where a 19 cm incision was made in my abdomen, along with another incision for a drainage tube.
The attending physician mentioned that fecal matter had leaked into the pelvis (which is my biggest concern).
According to what Director Ke said, there are no cases of appendicitis involving the colon, urethra, or bladder.
Therefore, I would like to ask if there are cases of peritonitis like mine that could involve the colon, urethra, or bladder.
Thank you, Director Ke.

A Cheng, 30~39 year old female. Ask Date: 2013/12/16

Dr. Ke Fangxu reply Surgery

Hello: The appendix is located in the lower right quadrant of the abdominal cavity.
If it becomes inflamed and ruptures, pus can flow down to the lowest part of the abdominal cavity, which is the pelvis.
This is a completely reasonable process and can lead to the formation of a colovesical fistula, commonly associated with conditions such as sigmoid colon inflammation, rectal cancer, or bladder cancer.
If you are still unable to feel reassured about undergoing a cystography, it may help to alleviate your concerns.
However, in the absence of any symptoms, suspecting a colovesical fistula solely based on cloudy urine may be an overestimation.
In medicine, there are no absolutes, only varying probabilities of occurrence.
In your case, I can only say that the likelihood of developing a colovesical fistula is indeed extremely low.

Reply Date: 2013/12/16

More Info

After undergoing surgery for appendicitis that progressed to peritonitis, it is understandable to have concerns about potential complications, especially regarding the presence of bubbles in your urine. The situation you described, where fecal matter may have leaked into the pelvic cavity, raises valid concerns about the possibility of a fistula, specifically a colovesical fistula, which is an abnormal connection between the colon and the bladder.

Colovesical fistulas can occur as a result of various conditions, including inflammatory diseases, malignancies, or surgical complications. In your case, the concern arises from the fact that fecal matter may have entered the pelvic cavity during the surgery. While it is true that cases of colovesical fistulas are not commonly reported following appendicitis, they can occur, particularly in the context of severe inflammation or infection.

The symptoms of a colovesical fistula can include:
1. Passing Gas or Feces in Urine: This is a classic sign of a colovesical fistula. If you notice any fecal material or gas in your urine, it is crucial to seek medical attention immediately.

2. Recurrent Urinary Tract Infections: Patients may experience frequent UTIs due to the abnormal connection between the bowel and bladder.

3. Urinary Symptoms: Increased frequency, urgency, or pain during urination can also be indicative of a fistula.

4. Abdominal Pain: Persistent or worsening abdominal pain, especially in the lower abdomen, may suggest complications.

Given your history of surgery and the presence of bubbles in your urine, it is essential to consult with your healthcare provider. They may recommend imaging studies, such as a CT scan or a cystogram, to evaluate for the presence of a fistula or other complications.
In terms of management, if a colovesical fistula is confirmed, treatment typically involves surgical intervention to repair the abnormal connection. The timing and approach to surgery will depend on the patient's overall health, the size and location of the fistula, and any associated complications.

It is also important to consider that the presence of bubbles in urine can sometimes be attributed to other factors, such as:
- Urinary Tract Infection (UTI): Infections can lead to the presence of bubbles due to the presence of bacteria or pus in the urine.

- Dehydration: Concentrated urine can sometimes appear bubbly.

- Proteinuria: The presence of excess protein in the urine can cause foaming.

In conclusion, while the risk of developing a colovesical fistula after appendicitis and peritonitis exists, it is not the most common outcome. However, given your symptoms and surgical history, it is crucial to follow up with your healthcare provider for a thorough evaluation. Early diagnosis and treatment are key to managing any potential complications effectively. Please do not hesitate to reach out to your doctor for further assessment and peace of mind.

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