Introduction
Ureteric stricture is reasonably common clinical problem. Short and soft strictures are easy to treat but long strictures need planned reconstruction like Boari flap, Intestinal loop or Autotransplantation. In select situation Appendix can be easy and effective substitution.
Case Report
38 year female presented with episodes of right flank pain and recurrent attacks of UTI. History of LSCS 8 year back and left pyelolithotomy 7 year back. Clinical examination and basic investigation were normal. Urine showed plenty of pus cells. IVU revealed right moderate hydronephrosis, partial duplication with dilated double ureters upto L-5 level. On DTPA scan right kidney had 35.7% function with obstructive pattern. Right RGP revealed long mid ureteric stricture in common stem. On exploration through right modified Gibson’s incision, evidence of dense periuretric fibrosis with 8 cm stricture segment overlying sacroiliac joint and bladder was thin walled. 7cm healthy appendix with adequate diameter was interposed from dilated ureters up to bladder.
Discussion
Middle ureteric stricture especially right sided; can be easily substituted with live appendicular interposition, if long healthy good calibre appendix is available. It is technically easy non morbid procedure. Additional advantages are minimal electrolyte disturbances and matching lumen size. Isoperistaltic or Antiperistaltic interposition should not matter. Insitu appendicular interposition has less risk of pedicle kink.
Conclusion
Appendix is valuable substitute in select cases for right ureteral stricture.
