Pyelo-duodenal fistula: a new method of closure

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.

[Pyeloduodenal Fistula Caused by Renal Calculi]

A fistula between the renal pelvis and duodenum (pyeloduodenal fistula) is very rare. It can occur spontaneously or after trauma to one of these organs. A spontaneous pyeloduodenal fistula is usually caused by chronic inflammation, including reactions to foreign bodies, nephrolithiasis, benign and malignant neoplasms, as well as pyogenic infections. The main treatment to date has been surgery. We encountered one case of pyeloduodenal fistula found during an evaluation for abdominal discomfort in a 39-year-old female. Pyeloduodenal fistula was diagnosed by upper gastrointestinal endoscopy and abdominal computed tomography, and it was caused by direct invasion of nephrolithiasis. Surgical operation was recommended, but the patient refused. The patient has been free of symptoms for four years. Herein, we report an unusual case of pyeloduodenal fistula without surgical management and relevant literature review.

Are Nephroenteric Fistulas Only a Surgical Trouble?

Nephroenteric fistulas can be secondary to different etiologies, the most common of which are pyelocolic fistulas. The absence of pathognomonic symptoms and the heterogeneity of presentation can sometimes result in a delay in diagnosis. We report on three cases: a pyelo-duodenal fistula secondary to kidney stones and subsequent pyonephrosis, a pyelocolic fistula due to inveterate ureteral stones with hydropyonephrosis, and a rare case of posttraumatic pyelocolic fistula. All patients were treated with radical nephrectomy and resection of the involved intestinal tract. Fistulas of the kidney with the gastrointestinal tract are complex not only for the surgical treatment, which is mandatory in the majority of cases, but also for clinical and instrumental diagnosis. Severe infection is a major concern due to the admixture of the enteric bacterial flora with the urinary tract. Nephroenteric fistulas require skilled surgical procedures, close control of the septic risk, management of patient's overall medical condition, and balance between invasive and conservative approach.

Spontaneous nephroduodenal fistula in a 27-year-old woman

Spontaneous nephroduodenal fistula formation is a rare occurrence. An otherwise healthy young patient presented with worsening chronic right flank pain and fevers. Retrograde pyelogram and computed tomography studies eventually led to a diagnosis and successful management of a right nephroduodenal fistula.

Nephroenteric fistula treated with fulguration of the fistulous tract

We report the management of a nephroenteric fistula with percutaneous fulguration in a patient with recurrent pyelonephritis and urolithiasis. A nephrostogram at 6 weeks and retrograde pyelogram at 18 weeks after fulguration showed no evidence of a recurrent fistula. We believe this to be the first reported case of a nephroenteric fistula treated successfully with fulguration.