Urinary tract infection in acute appendicitis

The effect of acute appendicitis (AA) on aerobic urinary tract infection was investigated. Abnormal urinalysis and urinary tract infection in patients with AA have seldom been reported previously. Appendectomy was performed in 84 patients with no previous urogenital, retroperitoneal, or pelvic disease, trauma or operation and AA was pathologically confirmed in 66 of them. Aerobic cultures of appendiceal tissue and mesenteriolum were done. Control groups included 25 patients with inguinal hernioplasty and 40 patients with varicocele repair. Urinalysis and urine culture were done prior to operation, and on days 1, 3, and 6 postoperatively. The "O" serogrouping identification of Escherichia coli (E. coli) was performed in the appendix, mesenteriolum and urine. Abnormal urinalysis was found in 48% of patients with AA before appendectomy, and in 12% on day 6 postoperatively (P < 0.05). Aerobes were isolated from urine in 32% of patients before appendectomy and in 24% on day 6 following surgery. E. coli was more often found in the appendix than in the mesenteriolum (P < 0.05). In seven out of 66 patients (11%) bacteriuria of more than 10(5) was found. All of them had identical aerobic strain isolated from the appendix, mesenteriolum and urine (E. coli in 4, Streptococcus faecalis in 2 and Corynebacterium species in one patient) according to antimicrobial susceptibility testing and "O" serogrouping of E. coli. Lower urinary tract infection was clinically manifested on day 3 postoperatively in 4 of them and in none from the control groups. Bacteria spreading from the appendix to the retroperitoneal space may invade the urinary tract and cause either symptomatic or asymptomatic urinary tract infection in patients with AA.