Primary repair of colorenocutaneous fistula in patients with genitourinary tuberculosis

Fistulas of the Genitourinary Tract: A Radiologic Review

Fistulas of the genitourinary tract have diverse anatomic locations, causes, and clinical features. They can involve the upper urinary tract (kidney, ureter), the lower urinary tract (bladder, urethra), or the female reproductive tract (vagina, uterus). Causes include infection, inflammatory disease, neoplasms, congenital conditions, trauma, and iatrogenic injury. Diagnosis of genitourinary tract fistulas usually requires radiologic studies performed with fluoroscopic or cross-sectional modalities. Fistulography is the most direct means of visualizing a fistula and should be considered when feasible (eg, cutaneous fistulas). Intravenous urography and pyelography or ureterography are mainstays of investigation of the upper tract. Likewise, voiding cystourethrography and urethrography are central to study of the lower tract. Cross-sectional techniques, in particular computed tomography, are increasingly useful for diagnosis and are considered the primary test in some cases. Radiologists should be familiar with the radiologic features of genitourinary tract fistulas for accurate diagnosis and treatment planning. Management approaches depend on the type of fistula, the degree of morbidity, and the overall functional status of the patient and vary from conservative observation to aggressive surgical repair.

Bile duct-duodenal fistula caused by AIDS/HIV-associated tuberculosis

Allthough infrequent, digestive fistulae in HIV/AIDS patients have been reported throughout the digestive tract from the esophagus to the anus, with predominance of esophageal fistulae. AIDS/HIV-associated opportunistic infections may invade the digestive system and lead to fistula formation. Tuberculosis is the most common infection associated with these esophageal fistulae. We report here one case of bile duct-duodenal fistula in a female AIDS patient with associated abdominal Mycobacterium tuberculosis infection compromising lymphnodes of the hepatic pedicle where the fistula was found. According to the reviewed literature, this is the third case of bile duct-duodenal fistula associated with abdominal tuberculosis in AIDS patient, and the first where both the fistula and the tuberculosis infection were diagnosed at laparotomy for acute abdomen. Whether the AIDS patient with abdominal pain needs or not a laparotomy to treat an infectious disease is often a difficult matter for the surgeon to decide, as most of the times appropriate medical treatment will bring more benefit.

[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.