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Published on: July 11, 2013
Conservative Management of a Pyelovenous Fistula After a Renal Gunshot Wound
Michael Stern1, Neel H Patel1, Brian Inouye2
1Department of Urology, New York Medical College, Valhalla, New York.
Abstract:
We report the diagnosis and management of a pyelovenous fistula that was detected 5 days after a renal gunshot wound (GSW). A 16-year-old boy presented to the trauma center with a single GSW to the right flank. CT scan revealed a shattered right kidney with active contrast extravasation and ureteral discontinuity, metal fragments in the L1 vertebra, and a bullet lodged in the upper pole of the left kidney. The patient was taken for emergent exploratory laparotomy. A right nephrectomy was performed. A left retrograde pyelogram demonstrated an intact collecting system. A left Double-J stent was placed to protect against delayed thermal injury. Repeat pyelogram on postoperative day 5 revealed a pyelovenous fistula and a stent was left in place. At 6 weeks, interval pyelogram showed complete resolution of the pyelovenous fistula and the stent was removed. At 6 months the patient was asymptomatic and normotensive with an unremarkable left kidney on ultrasonography. Pyelovenous fistula is a rare complication of a retained bullet in the kidney. Conservative management with ureteral stenting was effective in resolving the fistula.
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