Duodeno-ureteric fistula secondary to chronic duodenal ulceration

Renoalimentary fistulae are rare. When they occur, they are usually between the right renal pelvis and the duodenum. The primary pathology often resides in the kidney, and nephrectomy is often necessary in the management of such fistulae. We describe a case of an elderly man who presented with non-specific abdominal pains. He had a history of peptic ulcer which was treated with H2 antagonist. He was well for the past few years until recently when he experienced upper abdominal pains. Subsequent investigations showed a duodeno-ureteric fistula secondary to a chronic duodenal ulcer. The kidney was normal. Polya gastrectomy was performed and the patient recovered with complete resolution of his symptoms.