Pyeloduodenal fistula successfully treated by endoscopic ligation without surgical nephrectomy: case report

Surgical correction of multiple renoduodenal fistulas due to chronic pyelonephritis: a case report and literature review

Renoduodenal fistulas are a rare and uncommon phenomenon that account for ˂1% of those found between the urinary and intestinal tracts. Precipitation of this pathologic tract can be caused by chronic inflammation, necrosis, or ischemia. This case illustrates a 72-year-old man presenting with flank pain discovered to have multiple renoduodenal fistulas and our approach that led to the resolution of his symptoms. We review the pathophysiology, management, and effects of these fistulous tracts on renal function. Patients with staghorn calculi should undergo immediate evaluation for removal of the stone. In cases complicated by fistula formation, need for radical nephrectomy should be investigated and surgical repair should be pursued.

A traumatic enterorenal fistula

Enterorenal fistulas can arise from various spontaneous and traumatic etiologies. While nephrectomy is frequently the treatment of choice, renal sparing techniques have been described. We report a case of an enterorenal fistula as a complication of penetrating trauma. The fistula was managed conservatively with only ureteral stenting.

Renoduodenal Fistula Following Penetrating Abdominal Injury

Renoduodenal fistula is an uncommon occurrence and usually results as a complication of injury or inflammatory process. Here, we describe a case of renoduodenal fistula formation after traumatic injury via gunshot wound to the abdomen. The patient suffered right renal and ureteral injury, complicated by urine leak, managed by surgery, interventional radiology, and urology. His post-hospital course was complicated by recurrent urinary tract infections and was found to have a renoduodenal fistula 3 months after the initial operation. Patient underwent uncomplicated right nephrectomy and repair of fistula. Etiology, presentation, diagnosis, and treatment options of renoduodenal fistula are discussed.

Successful Endoscopic Closure of Pyeloduodenal Fistula Using an Over-the-Scope Clip

A 62-year-old woman underwent a series of urologic procedures for nephrolithiasis and was diagnosed with a pyeloduodenal fistula (PDF) on computed tomography urography. After the placement of a metallic ureteral stent and nephrostomy tube, an esophagogastroduodenoscopy was performed to evaluate for PDF resolution. Two areas of mucosal defects within the anterior duodenal sweep were closed using the over-the-scope clip system and hemostasis clips. We review the literature and discuss the etiologies, presentation, diagnosis, and treatment of PDF. This is the second documented case of endoscopic PDF closure using the over-the-scope clip system and the third case of endoscopically treated PDF.

Reno-duodenal fistula as a complication of longstanding renal tract calculus

We present a rare case detailing the investigations and subsequent treatment of a lady who presented with a reno-duodenal fistula and perinephric abscess as a complication of staghorn calculus and recurrent upper urinary tract infections. Treatment involved antibiotics, nephrostomy, endoscopic closure of the fistula tract with clips, radiological drain insertion and, ultimately, nephrectomy with primary omental patch closure of the duodenal defect. We discuss the incidence of fistula tract formation as a complication of staghorn calculi, as well as investigations and management strategies employed in the literature to treat such complications, which span from conservative treatment to nephrectomy and closure of the intestinal defect. We illustrate the post-operative complications such patients are prone to and discuss these in context of the case. Whilst such cases are rare clinicians should be vigilant for complications associated with chronic inflammatory processes occurring in the urinary tract and investigate accordingly.

Spontaneous renoalimentary fistula as a complication of upper tract urothelial carcinoma: unknown complication of a rare disease

Fistulae of the upper urinary tract with the alimentary tract are rare. Most cases of renoalimentary fistulae are secondary to penetrating trauma, which may be iatrogenic or due to locally invasive benign infective processes or complicated nephrolithiasis, or following surgical procedures. Spontaneous renoalimentary fistulae developing secondary to locally advanced malignancies, namely renal cell carcinoma, are very rare, and unknown due to upper tract transitional cell carcinoma. We present a case where a 60-year-old man, presented with clinical symptoms suggestive of upper gastrointestinal tract pathology, with no urological complaints and was diagnosed to have a renoalimentary fistula on cross-sectional imaging and upper gastrointestinal endoscopy with histopathology of duodenal growth biopsy showing high-grade transitional cell carcinoma. Due to unresectable nature of this mass, this patient had a gastric and biliary diversion and was started on palliative chemotherapy. Renoalimentary fistulae due to benign inflammatory causes may be treated by nephrectomy with or without resection of the involved bowel segment. However, all malignant fistulae have to be treated as locally advanced tumours and en bloc resection should be attempted whenever feasible.

[Pyeloduodenal Fistula Caused by Renal Calculi]

A fistula between the renal pelvis and duodenum (pyeloduodenal fistula) is very rare. It can occur spontaneously or after trauma to one of these organs. A spontaneous pyeloduodenal fistula is usually caused by chronic inflammation, including reactions to foreign bodies, nephrolithiasis, benign and malignant neoplasms, as well as pyogenic infections. The main treatment to date has been surgery. We encountered one case of pyeloduodenal fistula found during an evaluation for abdominal discomfort in a 39-year-old female. Pyeloduodenal fistula was diagnosed by upper gastrointestinal endoscopy and abdominal computed tomography, and it was caused by direct invasion of nephrolithiasis. Surgical operation was recommended, but the patient refused. The patient has been free of symptoms for four years. Herein, we report an unusual case of pyeloduodenal fistula without surgical management and relevant literature review.