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Hillman E, Fu H, Anele U. Colo-renal Fistula in a Patient With Refractory Anemia and Recurrent Urinary Tract Infections: A Case Report and Review of the Literature. Cureus 2023; 15:e44741. [PMID: 37680258 PMCID: PMC10480093 DOI: 10.7759/cureus.44741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/09/2023] Open
Abstract
Although rare, colo-renal fistulas pose diagnostic challenges due to their varied presentations and etiologies. Here, we present a unique case of a woman with recurrent pyelonephritis, severe anemia, and unintended weight loss, who was eventually diagnosed with a colo-renal fistula. Delayed imaging following intraoperative fluoroscopy revealed the abnormal connection between the colon and upper urinary tract. The patient underwent nephrectomy and colon resection. This case report emphasizes the need for suspicion in diagnosing such fistulas and highlights their varied management. This case adds to the literature by illustrating an unusual presentation and underscores the complexity of diagnosis and treatment.
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Affiliation(s)
- Emily Hillman
- Urology, University of Louisville School of Medicine, Louisville, USA
| | - Hangcheng Fu
- Urology, University of Louisville School of Medicine, Louisville, USA
| | - Uzoma Anele
- Urology, University of Louisville School of Medicine, Louisville, USA
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2
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Lee JSZ, Hall J, Sutherland T. Complications of renal interventions: a pictorial review of CT findings. Insights Imaging 2021; 12:102. [PMID: 34275011 PMCID: PMC8286918 DOI: 10.1186/s13244-021-01048-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
A number of potential vascular and non-vascular complications can arise from surgical, extracorporeal shock wave lithotripsy, radiotherapy and radiological renal interventions, including percutaneous image-guided biopsy and drainage. Computed tomography scan is usually one of the first and most important diagnostic imaging examinations requested when a potential complication is suspected. There are a wide range of common and uncommon potential complications from renal interventions. An understanding of underlying risk factors is important to reduce potential complications from renal intervention. Radiologists play a crucial role in recognising and diagnosing post-renal intervention complications on computed tomography scans, which could significantly improve the patient’s prognosis.
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Affiliation(s)
- Jean S Z Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Tom Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
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Lulla T, Sheng J, Maheshwari V, Bhalla R. Management of Left Staghorn Calculus With Colorenal Fistula. Urology 2021; 154:e13-e14. [PMID: 33991576 DOI: 10.1016/j.urology.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Fistula formation between the kidney and the colon is a rare occurrence. Colorenal fistulas have been reported after renal cryoablation, calculous pyonephrosis, and renal cell carcinoma. Fistula formation is reported in as many as 35% of patients with Crohn's disease. Crohn's-related urinary fistulas may include enterovesical, enteroureteral, rectourethral, urethrocutaneous, and entero-urachal fistulas. Here, we report a rare case of a patient who was found to have a left colorenal fistula in the setting of a left staghorn calculus and recurrent urinary tract infections with a question about the eventual definitive management of the patient.
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Affiliation(s)
- Tina Lulla
- Rutgers New Jersey Medical School, Division of Urology, Newark, NJ
| | - John Sheng
- Rutgers New Jersey Medical School, Division of Urology, Newark, NJ.
| | - Vivek Maheshwari
- RWJ BarnabasHealth, Saint Barnabas Medical Center, Department of Surgery, Livingston NJ
| | - Rahuldev Bhalla
- Rutgers New Jersey Medical School, Division of Urology, Newark, NJ; RWJ BarnabasHealth, Saint Barnabas Medical Center, Division of Urology, Livingston, NJ
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Miyazaki M, Komatsu Y, Yoshihara T, Kimura S. Bowel injury complicating percutaneous cryoablation of large renal cell carcinoma. Radiol Case Rep 2020; 15:580-585. [PMID: 32215157 PMCID: PMC7083791 DOI: 10.1016/j.radcr.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 10/29/2022] Open
Abstract
We report the case of a bowel injury, which occurred after the percutaneous cryoablation (PCA) of large renal cell carcinoma (RCC). A 50-year-old man with RCC measuring 47 mm in diameter. First, we performed transarterial embolization for the tumor, followed by PCA with hydrodissection, which displaced the small intestine from the iceball. The procedure was completed without any complication on the procedural day; however, the patient complained of appetite loss and abdominal pain 2 days after PCA. Computed tomography revealed a bowel injury at the small intestine adjacent to the tumor. After 7 days, ileus tube insertion, and fasting, the patient recovered from the bowel injury and was discharged 10 days after PCA. He underwent a second PCA because of a small recurrent renal tumor 5 months after the first PCA without complications. This case indicated that a bowel injury after PCA for RCC could be treated conservatively.
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Affiliation(s)
- Masaya Miyazaki
- Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Yuki Komatsu
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Terutaka Yoshihara
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Shintaro Kimura
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, Maebashi, Gunma, Japan
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Brinded A, Tay YK, Woods R. Novel case of nephrocolic fistula secondary to stereotactic ablative body radiotherapy for clear cell renal cell carcinoma. ANZ J Surg 2020; 90:1800-1801. [PMID: 31989764 DOI: 10.1111/ans.15688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/11/2019] [Accepted: 12/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Alex Brinded
- Colorectal Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Yeng Kwang Tay
- Colorectal Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Rodney Woods
- Colorectal Surgery Unit, St Vincent's Hospital, Melbourne, Victoria, Australia
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Akbani S, Wolf JS, Osterberg EC. Enterorenal Fistula as an Unusual Complication from Ureteroscopic Lithotripsy: A Case Report. J Endourol Case Rep 2019; 5:49-52. [PMID: 31179384 PMCID: PMC6555179 DOI: 10.1089/cren.2018.0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This case highlights an enterorenal fistula as a rare complication from ureteroscopic lithotripsy. Case Presentation: A 56-year-old woman with significant obesity, decompensated cirrhotic and ascitic liver disease, hypertension, type 2 diabetes mellitus, and nephrolithiasis treated with five prior ureteroscopic lithotripsies for a partial left staghorn stone presented to the emergency department (ED) with worsening left flank pain and sepsis. A CT scan of the abdomen and pelvis with contrast showed a large left perinephric hematoma. She underwent drain placement and during fluoroscopic imaging, there was a fistula from the left subcapsular hematoma/abscess to the proximal descending colon. The patient wished to proceed with a surgical course involving nephrectomy with hemicolectomy despite extensive counseling regarding her high mortality risk. However, because of worsening nutritional status as well as several other high-risk comorbidities, a shared decision was made with the patient to postpone the procedure. The patient was discharged to a skilled nursing facility for nutritional optimization and prehabilitation; however, she continued to decline with recurrent sepsis and cirrhosis-related complications and unfortunately passed away. Conclusion: A subscapular hematoma evolving into a perinephric abscess is a rare but known complication of ureteroscopic lithotripsy; however, this patient developed an enterorenal fistula that has yet to be reported after repeated ureteroscopy.
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Affiliation(s)
- Sabah Akbani
- Department of Surgery and Perioperative Care, Division of Urology, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - J Stuart Wolf
- Department of Surgery and Perioperative Care, Division of Urology, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - E Charles Osterberg
- Department of Surgery and Perioperative Care, Division of Urology, Dell Medical School at the University of Texas at Austin, Austin, Texas
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Thiyagarajan D, Hughes M, Tamarkin F, Zighelboim I. Renocolic fistula secondary to curative intent extended field radiotherapy for cervical cancer. Gynecol Oncol Rep 2018; 26:66-68. [PMID: 30364558 PMCID: PMC6197436 DOI: 10.1016/j.gore.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/09/2018] [Indexed: 11/29/2022] Open
Abstract
Renocolic fistula is a rare complication from extended field radiation. Pathogenesis may involve colonic mucosal ischemia from radiation-induced colitis. Conservative management with urethral stenting can result in complete resolution.
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Affiliation(s)
- Dhanalakshmi Thiyagarajan
- Lewis Katz School of Medicine at Temple University/St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Michael Hughes
- Lewis Katz School of Medicine at Temple University/St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
- Department of Urology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Frank Tamarkin
- Division of Urologic Surgery, St. Luke's University Health Network, 701 Ostrum Street, Bethlehem, PA 18015, USA
| | - Israel Zighelboim
- Division of Gynecologic Oncology, St. Luke's University Health Network, 701 Ostrum Street, Bethlehem, PA 18015, USA
- Corresponding author at: 701 Ostrum Street, Suite 502, Bethlehem, PA 18015, USA.
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Abstract
A 77-year-old man presented with watery, bloody diarrhoea, symptomatic anaemia and signs of sepsis. He was well known to our unit with a history of extensive low-grade urothelial carcinoma involving a solitary kidney. CT performed on admission demonstrated a new finding of renocolic fistula. Due to his multiple medical and surgical comorbidities conservative management was elected. He passed away after 1 year of follow-up.
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Affiliation(s)
- Michael Auld
- General Surgery, Queensland Health, Ipswich, Queensland, Australia
| | - Andrew Keller
- Urology, Queensland Health, Ipswich, Queensland, Australia
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Duodenorenal Fistula after Microwave Ablation Presenting as Melena. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805100-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ashfaq A, Ferrigni R, Mishra N. Laparoscopic approach to colo-renal fistula with renal preservation and omentoplasty: A case report. Int J Surg Case Rep 2017; 35:53-56. [PMID: 28437674 PMCID: PMC5403794 DOI: 10.1016/j.ijscr.2017.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/29/2022] Open
Abstract
Percutaneous ablation is being increasingly used to treat renal masses. A colo-renal fistula can result as a potential complication. Initial treatment should focus on conservative management involving antibiotics and ureteral stent placement. If failed, fistula can be resected laparoscopically safely without the need for nephrectomy.
Colorenal fistula as a result of percutaneous cryoablation has not been extensively reported. We report a gentleman who presented with urosepsis after percutaneous biopsy of a renal mass complicated by colorenal fistula. After failed attempts at conservative management, he underwent laparoscopic resection of his fistula with renal salvage and omentoplasty highlighting that nephrectomy is not always indicated.
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Affiliation(s)
- Awais Ashfaq
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, AZ, United States.
| | | | - Nitin Mishra
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, AZ, United States
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Are Nephroenteric Fistulas Only a Surgical Trouble? Indian J Surg 2015; 77:222-5. [PMID: 26246706 DOI: 10.1007/s12262-014-1046-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022] Open
Abstract
Nephroenteric fistulas can be secondary to different etiologies, the most common of which are pyelocolic fistulas. The absence of pathognomonic symptoms and the heterogeneity of presentation can sometimes result in a delay in diagnosis. We report on three cases: a pyelo-duodenal fistula secondary to kidney stones and subsequent pyonephrosis, a pyelocolic fistula due to inveterate ureteral stones with hydropyonephrosis, and a rare case of posttraumatic pyelocolic fistula. All patients were treated with radical nephrectomy and resection of the involved intestinal tract. Fistulas of the kidney with the gastrointestinal tract are complex not only for the surgical treatment, which is mandatory in the majority of cases, but also for clinical and instrumental diagnosis. Severe infection is a major concern due to the admixture of the enteric bacterial flora with the urinary tract. Nephroenteric fistulas require skilled surgical procedures, close control of the septic risk, management of patient's overall medical condition, and balance between invasive and conservative approach.
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A Rare Case of Nephrocolic Fistula Resulting from Radio Frequency Ablation (RFA) of Renal Cell Carcinoma. ACG Case Rep J 2014; 1:93-5. [PMID: 26157836 PMCID: PMC4435279 DOI: 10.14309/crj.2014.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/18/2013] [Indexed: 11/17/2022] Open
Abstract
Nephrocolic fistula is a rare, abnormal fistulous connection between the urinary system (kidney/ureters) and colon. Different benign and malignant etiologies are implicated in the formation of a nephrocolic fistula. Even though conservative treatment options have been tried recently (especially for benign etiologies), surgical resection has been the treatment of choice and should be pursued if conservative management fails. We report the first case of a nephrocolic fistula after a radiofrequency ablation of a renal cell carcinoma, which required surgical resection after conservative management failed.
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Morgan AI, Doble A, Davies RJ. Successful conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors: a case report. J Med Case Rep 2012; 6:365. [PMID: 23101875 PMCID: PMC3514191 DOI: 10.1186/1752-1947-6-365] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 09/12/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction Colorenal fistula is a rare phenomenon and may complicate percutaneous cryoablation of renal cell carcinoma. Treatment remains controversial. Case presentation A 62-year-old Caucasian man presented with pneumaturia and left flank pain six weeks following ultrasound-guided percutaneous cryoablation of two recurrent lesions in the left kidney 14 years after partial left nephrectomy for a left renal cell carcinoma. A computed tomography scan eight weeks after cryoablation revealed a cryoablated mass with adjacent stranding and adherent descending colon as well as bubbles of gas in the area of stranding, the left collecting system, and the bladder. These features were consistent with a colorenal fistula at the site of previous ablation. Successful resolution of the fistula, both clinical and radiological, was achieved following a complete conservative non-interventional out-patient approach. No ureteric stent or surgical intervention was employed. Conclusions In the absence of severe symptoms or sepsis, complete conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors should be considered prior to interventional stenting or resectional surgery.
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Affiliation(s)
- Amir Is Morgan
- Cambridge Colorectal Unit and Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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