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Nephrocolocutaneous fistula from a staghorn calculus
Cesar Karunungan Jacinto1, Michael Geoffrey Lee Lim2, Marc Paul Jose Lopez2
1Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines rocky_awp@yahoo.com.
BMJ Case Reports
|January 18, 2023
Summary
A rare case of a kidney, colon, and skin fistula (nephrocolocutaneous fistula) was reported in a developing country. This extremely rare condition, often linked to tuberculosis, highlights the need for vigilance in diagnosing complex renal infections.
Area of Science:
- Urology
- Nephrology
- Gastroenterology
Background:
- Nephrocolic and nephrocolocutaneous fistulas are rare complications of renal infections, historically linked to genitourinary tuberculosis.
- Improved diagnostics and anti-tuberculosis therapies have reduced the incidence of these fistulas, particularly in developed nations.
Observation:
- A 20-year history of a left flank lesion with purulent discharge presented as urosepsis.
- Contrast-enhanced CT and fistulogram revealed a staghorn calculus in the left kidney with connections to the descending colon and skin.
Findings:
- The patient had a complex nephrocolocutaneous fistula secondary to a staghorn calculus.
- Surgical intervention included left hemicolectomy with en bloc excision of the kidney and fistula tract.
Implications:
- This case underscores the persistent risk of rare renal-enteric fistulas in developing countries.
- Highlights the importance of considering complex etiologies for chronic flank lesions and recurrent infections.
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