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Renocolic fistula following percutaneous nephrostomy: a case report
P R Chalise1, U K Sharma, P R Gyawali
1Urology Unit, Department of surgery, Tribhuvan University Teaching Hospital, Maharajgung, Kathmandu, Nepal. pawan_rc@yahoo.com
Abstract:
Renocolic fistula is a rare clinical entity. In the past, its incidence was high due to infection, especially tuberculosis, and renal stone complications; which gradually reduced with advancements in antimicrobial therapy and better stone management. The incidence of renocolic fistulae, specifically iatrogenic one, has re-emerged due to minimally invasive renal surgery and regular percutaneous nephrostomy placement for various reasons. We reported a case of fifty-five-years-old gentleman who presented to emergency room with left lithiasic pyonephrosis for which percutaneous nephrostomy was placed. Follow up antegrade pyelography diagnosed hydronephrotic left kidney with stone in renal pelvis with fistula communicating to descending colon. Contrast enhanced computer tomography revealed left non excreting kidney with retrorenal colon and percutaneous nephrostomy tube passing through the descending colon. The final diagnosis of post percutaneous nephrostomy renocolic fistula with non excreting left kidney was made and treated with ligation of fistulous tract and nephrectomy. Patient had uneventful recovery and histopathology showed chronic pyelonephritis.
Insights
Renocolic fistula, a rare condition, is increasingly seen after percutaneous nephrostomy. This case highlights a post-procedure fistula requiring nephrectomy for treatment.
Area of Science:
- Urology
- Nephrology
- Gastroenterology
Background:
- Renocolic fistula is a rare condition historically linked to infections like tuberculosis and renal stones.
- Advancements in antimicrobial therapy and stone management reduced its incidence.
- Iatrogenic renocolic fistulae are re-emerging due to minimally invasive renal surgery and percutaneous nephrostomy.
Observation:
- A 55-year-old male presented with left lithiasic pyonephrosis requiring percutaneous nephrostomy.
- Antegrade pyelography revealed a hydronephrotic kidney with a stone and a fistula to the descending colon.
- CT scan confirmed a non-excreting left kidney, retrorenal colon, and the nephrostomy tube traversing the colon.
Findings:
- The patient was diagnosed with a post-percutaneous nephrostomy renocolic fistula with a non-excreting left kidney.
- Treatment involved ligation of the fistulous tract and nephrectomy.
- Histopathology confirmed chronic pyelonephritis.
Implications:
- This case underscores the risk of renocolic fistula formation following percutaneous nephrostomy.
- It highlights the importance of diagnostic imaging in identifying such rare complications.
- Surgical intervention, including nephrectomy, may be necessary for effective management.
