Late complication of a renal calculus: fistulisation to the psoas muscle, skin and bronchi

Abstract

Kidney disease presenting with cutaneous fistula is a rare condition. We present a case of a 90-year-old woman with dementia who had no prior urological problems and had a cutaneous fistula in the left lumbar region. A fistulogram and computer tomography examination revealed a large staghorn calculus with signs of xanthogranulomatous pyelonephritis in the left kidney and renal fistulisation to the psoas muscle, skin and bronchi. To our knowledge this is the first report in the literature of coexisting renal fistulisation to the psoas major muscle, skin and bronchi. This report illustrates how computed tomography in combination with fistulography can resolve the diagnostic dilemma that pertains to the complex spread of the disease in cases involving nephrocutaneous fistula. Furthermore, the report shows how a renal calculus, even asymptomatic, can cause a serious medical condition, and highlights the importance of early medical intervention.

Xanthogranulomatous pyelonephritis: a case with rare adhesion to pancreas

“…It has been described as a great imitator, even it is often misdiagnosed as a renal mass [10]. Fistula formations were reported as directed to skin, psoas muscle, and intestine tissues among stage III diseases [11]. Conversely, the present case was divergent because there was no determined obstructing calculus.…”

Nephrocutaneous fistula due to renal stone disease presenting as non-healing abdominal wall sinus: lessons from two cases

“…The obstruction and infection of urinary system caused by staghorn calculi might rarely lead to pyonephrosis and xanthogranulomatous pyelonephritis (XGP). In neglected and untreated cases, infection may extend to involve Gerota's fascia, perinephric fat and sometimes may rupture through overlying skin in the flank region as happened in both of our cases [2]. Both of our patients were poor, uneducated labourers with rural background and might have neglected the mild symptoms of renal stone disease leading to this complication.…”

“…If remained neglected, the inflammatory process may extend beyond kidney leading to perinephric abscess. Rarely, this abscess may rupture through abdominal wall presenting as non-healing sinus in the flank region [1,2]. The authors report two such unusual cases that were managed successfully by subcapsular nephrectomy.…”

Spontaneous extrusion of staghorn renal calculus with nephrocutaneous fistula in a child

“…Spontaneous expulsion of renal stones may be due to renal trauma, renal tumour, previous surgery or chronic infection 1 2. Association of spontaneous extrusion of renal stones and spontaneous nephrocutaneous fistula,3 as reported here, is even rarer.…”