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Reno-Duodenal Fistula Caused by Metastatic Lung Cancer
Deepa Raghavan1, Nikhil Vojjala2,3, Rishab Prabhu2,4
1Wayne State University School of Medicine.
Journal of Brown Hospital Medicine
|July 4, 2025
Summary
Reno-duodenal fistulas are a rare complication of lung cancer radiotherapy. This case highlights the need to consider this rare diagnosis in patients with similar symptoms and history.
Area of Science:
- Oncology
- Gastroenterology
- Radiotherapy
Background:
- Metastatic lung cancer patients treated with chemoradiation are at risk for rare complications.
- Reno-alimentary fistulas are an extremely rare sequela of radiotherapy.
Observation:
- A 60-year-old male with metastatic non-small cell lung cancer presented with sepsis.
- Imaging revealed a reno-duodenal fistula, a rare complication post-chemoradiation.
- Endoscopic closure failed, and the patient was transitioned to hospice.
Findings:
- The patient developed septic shock with polymicrobial bacteremia and fungemia.
- A reno-duodenal fistula was identified as the source of infection.
- The fistula was not amenable to surgical or endoscopic intervention due to disease progression.
Implications:
- This case underscores the importance of considering reno-alimentary fistulas in the differential diagnosis of emphysematous pyelonephritis.
- Early recognition and diagnosis are crucial for appropriate management, even in palliative settings.
- Highlights the severe, albeit rare, complications of combined chemoradiation therapy in advanced cancer patients.
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