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Pyeloduodenal fistula: a review of the current literature
K Spanggaard1, N K Hvid2, M Diatchikhine2
1Department of Urology, Odense University Hospital, Odense, Denmark. Karen.Spanggaard@rsyd.dk.
Insights
Pyeloduodenal fistula (PDF) is a rare condition often linked to kidney inflammation. Diagnosis typically involves CT scans, with nephrectomy being a common treatment, sometimes alongside TPN.
Area of Science:
- Urology
- Gastroenterology
- Medical Imaging
Background:
- Pyeloduodenal fistula (PDF) is a rare communication between the renal pelvis and duodenum.
- It is frequently a secondary condition, making it infrequently documented.
Purpose of the Study:
- To review current literature on pyeloduodenal fistulas.
- To provide an update on PDF etiology, symptoms, diagnostic methods, and treatments.
Main Methods:
- Literature search of PubMed, Cochrane Library, and Embase databases.
- Included English and Scandinavian language articles with abstracts from Jan 2000 to Dec 2023.
- Analysis of 24 original articles detailing 25 cases of PDF.
Main Results:
- Spontaneous PDFs primarily affected the right kidney, often due to calculi and pyonephrosis.
- Common symptoms included fever (67%) and flank pain (57%).
- CT urography or antegrade pyelography achieved 80% diagnostic accuracy; nephrectomy was performed in over 50% of cases.
Conclusions:
- PDF commonly involves the right kidney and arises from chronic renal inflammatory disease.
- CT scanning with contrast or retrograde pyelography are effective diagnostic tools.
- Nephrectomy, often with duodenal closure and TPN, is the most frequent management strategy.
Purpose:
Pyeloduodenal fistula (PDF) is a communication between the renal pelvis and the duodenum. It is often secondary to other diseases. It is a rare condition and therefore infrequently described in the literature. The aim is to present a review of the current literature on PDF and to give an update of its aetiology, symptoms, investigations and treatments.
Methods:
Pubmed, Cochrane Library and Embase were used to search for existing literature in English and Scandinavian languages with available abstracts in the period Jan 2000-Dec 2023.
Results:
No meta-analysis or reviews were found. In total, 24 original articles were found, including 25 cases all in all of both traumatic and spontaneous pyeloduodenal fistulas. Only four cases (15%) represented traumatic pyeloduodenal fistulas, and all of the spontaneous cases involved the right kidney and occurred due to calculi and pyonephrosis in 81% and 76% of the cases, respectively. Fever and flank pain were reported in 67% and 57% of the cases, respectively. Diagnosis was done by a CT urography or antegrade pyelography in 80% of the cases. More than 50% of all cases were managed by nephrectomy. Total parenteral nutrition (TPN) was administered alongside the nephrectomy in 28% of all cases.
Conclusion:
A pyeloduodenal fistula often involves the right kidney and often occurs as a result of chronic renal inflammatory disease. The fistulas are most efficiently diagnosed with a CT scanning with contrast or retrograde pyelography. The most frequently used management of pyeloduodenal fistula is nephrectomy after closure of the duodenum with somatostatin and TPN.
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