Pyeloduodenal fistula due to tuberculosis

Une Liaison Dangereuse: Spontaneous Pyeloduodenal Fistula

We describe the case of a 76-year-old woman with a spontaneous nephroduodenal fistula. The patient was initially evaluated for gastrointestinal and urinary symptoms associated with fever and anemia, after which she was admitted with the diagnosis of right chronic pyelonephritis, hydronephrosis, and renal lithiasis. The fistula was diagnosed incidentally by percutaneous pyelography during a right nephrostomy and was later confirmed with an abdominal CT scan. A multidisciplinary decision was made to surgically treat the fistula (right nephrectomy plus duodenal repair); the surgery had a short-term positive outcome. We report a systematic review of the literature related to spontaneous pyeloduodenal fistulæ and their treatments.

Duodenal tuberculosis; uncommon cause of gastric outlet obstruction

Gastrointestinal tuberculosis manifesting as isolated duodenal involvement is uncommon. We present a case of 52 years old man with post-prandial abdominal pain, early satiety and weight loss. Upper endoscopy showed circumferential duodenal stricture adjacent to the ampulla with nodularity, erythema, and ulcerations of the overlying mucosa causing gastric outlet obstruction. Biopsy of duodenal stricture revealed chronic duodenitis and the patient was treated with acid suppression therapy. Endoscopic balloon dilation was also performed with no response. Abdominal computer tomography scan showed multiple enlarged abdominal lymph nodes and subsequent duodenal tissue culture was positive for Mycobacterium tuberculosis. His symptoms and duodenal stricture resolved completely after treatment with anti-tuberculous regimen.

Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part I

Tuberculosis (TB) remains a worldwide scourge and its incidence appears to be increasing due to various factors, such as the spread of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The insidious onset and non-specific constitutional symptoms of genitourinary tuberculosis (GUTB) often lead to delayed diagnosis and rapid progression to a non-functioning kidney. Due to hematogenous dissemination of TB, there is a potential risk of involvement of the contralateral kidney too. Imaging plays an important role in the making of a timely diagnosis and in the planning of treatment, and thus helps to avoid complications such as renal failure. Imaging of GUTB still remains a challenge, mainly on account of the dearth of literature, especially related to the use of the newer modalities such as magnetic resonance imaging (MRI). This two-part article is a comprehensive review of the epidemiology, pathophysiology, and imaging findings in renal TB. Various imaging features of GUTB are outlined, from the pathognomonic lobar calcification on plain film, to finer early changes such as loss of calyceal sharpness and papillary necrosis on intravenous urography (IVU); to uneven caliectasis and urothelial thickening, in the absence of renal pelvic dilatation, as well as the hitherto unreported 'lobar caseation' on ultrasonography (USG). Well-known complications of GUTB such as sinus tracts, fistulae and amyloidosis are described, along with the relatively less well-known complications such as tuberculous interstitial nephritis (TIN), which may remain hidden because of its 'culture negative' nature and thus lead to renal failure. The second part of the article reviews the computed tomography (CT) and MRI features of GUTB and touches upon future imaging techniques along with imaging of TB in transplant recipients and in immunocompromised patients.

[Cutaneo-reno-colonic fistula in tubercular kidney with staghorn calculus: report of a case]

We report a rare case of colorenocutaneous fistula, in a patient with a stone of the left kidney. The fistula was successfully managed by single stage surgery (nephrectomy, fistulectomy and suture of colon). Histopathological examination revealed renal tuberculosis. Surgery was completed by an anti-tubercular treatment.

Pyeloduodenal fistula: a previously undescribed complication of Stamm gastrostomy

A variety of complications have been described after placement of a Stamm gastrostomy in infants and children, including gastric volvulus, pancreatitis, jaundice, gastroduodenal mucosal intussusception with gastric outlet obstruction, and even aortogastric fistula. However, this is the first report of pyeloduodenal fistula after Stamm gastrostomy in a 4 1/2-month-old boy. The child successfully underwent nonoperative therapy; he was treated by withdrawing the gastrostomy tube (Foley catheter) from the renal pelvis, bowel rest, and total parenteral nutrition. After the case presentation is a brief review of this rare entity, with its clinical presentation and pathophysiological differences between adult and pediatric cases. Various treatment options, both operative and nonoperative, are also described.

Pyeloduodenal fistula

Twenty-eight cases of pyeloduodenal fistula are reviewed from the standpoint of pathogenesis, clinical presentation, diagnosis, and management. Our review suggests the majority of these fistulas involved the right kidney and occurred as a result of chronic renal inflammatory disease. The fistulas are most effectively diagnosed with retrograde pyelography. The review suggests the best management of pyeloduodenal fistula is nephrectomy and primary closure of the duodenum.

Pyeloduodenal fistula: a case report and review of the literature

A case of the rare condition of pyeloduodenal fistula is presented--the thirty-second case so far recorded in the literature. The authors consider that this instance shows some of the features typical of the cases so far reported. The literature is reviewed and the aetiology, presentation, diagnostic methods and treatment are briefly discussed.