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Renoalimentary fistula: Case report of a renoduodenal fistula and systematic literature review

2018; Elsevier BV; Volume: 18; Linguagem: Inglês

10.1016/j.eucr.2018.02.022

2214-4420

Wilson Lin, Kara Watts, Ahmed Aboumohamed,

Kidney Stones and Urolithiasis Treatments

Fistulae between the renal and gastrointestinal (GI) systems are rare, constituting less than one percent of all fistulous connections between the urinary and intestinal tracts.1 We present a patient with a two-month history of flank pain and fevers who was found on imaging to have a right renal calculus and emphysematous pyelonephritis associated with a renoduodenal fistula. We also present a systematic literature review of the etiologies and frequencies of renoalimentary fistulae. Case presentation Our patient is a 76-year-old female with anemia, hypertension, diabetes mellitus, coronary artery disease, atrial fibrillation, and cerebrovascular accident who was transferred to the emergency department (ED) from her nursing home for concerns of sepsis. In the ED, she reported intermittent right flank pain and subjective fevers for the past two months. On physical examination, she was febrile to 102 °F with a heart rate of 122 and blood pressure of 131/55. Her physical exam was non-focal, with no localizing tenderness. Initial laboratory studies were significant for leukocytosis (white blood cell count 19,000; 82% neutrophils) and a urinalysis suspicious for infection. The patient was started on empiric ceftriaxone for urosepsis and admitted for antibiotic treatment. An abdominal ultrasound was performed, showing echogenic foci within the right renal collecting system and parenchyma concerning for emphysematous pyelonephritis. A subsequent abdominal computed tomography (CT) scan revealed a staghorn calculus in the right kidney complicated by emphysematous pyelonephritis and a 22 × 9 × 5 cm retroperitoneal abscess (Fig. 1). A nephrostomy catheter was then placed into the right renal pelvis by interventional radiology. During the procedure, an antegrade nephrostogram revealed a fistulous connection between the right collecting system and the small bowel. Six days later, after medical optimization, the patient underwent a combined right nephrectomy, retroperitoneal abscess drainage, separation of fistulous tract, and primary duodenal repair (Fig. 2). Open in a separate window Fig. 1 Coronal and axial views of abdominal CT scans showing a staghorn calculus in the right kidney complicated by emphysematous pyelonephritis and a retroperitoneal abscess.