A case with fistula formation between a perinephric retroperitoneal abscess, a ureter and a descending colon: Successful outcome after conservative management

Abstract

A 72-year-old man diagnosed with hydronephrosis and perinephric abscess because of an impacted urinary stone in the left ureteropelvic junction was admitted to hospital with high-grade fever. The insertion of a percutaneous drain improved his general condition. Then, imaging from the percutaneous drainage tube revealed a fistula formation between the cavity of the perinephric retroperitoneal abscess, the descending colon, and the left renal pelvis. The patient received conservative management, including insertion of a percutaneous drain, discontinuation of oral intake and antimicrobial chemotherapy. Three days after the percutaneous drainage and discontinuation of oral intake, imaging revealed no apparent fistula. Fistula formation between a perinephric abscess and the descending colon is very rare; this is the first case of a long-term favourable outcome by conservative management.

Successful Conservative Management of a Retroperitoneal Abscess With a Sinus to the Colon: A Case Report

“…The authors reported that less than 1 week of drainage was sufficient to evacuate the abscess and close the fistula. 1,9 However, the fistula tract in that case was minimally detectible and had a long tract, which are both favorable conditions for spontaneous closure. In our patient, the defect in the colon wall was almost 2 cm in diameter, and the tract was short.…”

Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study

“…A similar result was found in the present study. A slight predominance in Table 5 The antibiotic resistance rate of causative pathogens isolated pain, flank mass, signs of sepsis, weight loss, fistula formation and urinary tract complaints [2,4,15,22] . However, patients with RA were more likely subjected to lethargy in this study.…”

“…However there is a continuing argument about the proper treatment of middlesized abscesses [3,5,7,16] . Although the option of conservative management of RAs and PNAs seems attractive and feasible and successful cases have been reported [4,16] , those cases were selected and limitations in size, location and num ber of abscesses were obvious and in Iwamoto's case, the patient had received percutaneous drainage prior to conservative treatment [4] . In the present study, interventional approaches helped to detect the cause of disease and confirm the diagnosis, and culture of pus/aspirate/debris helped guide selection of an antibiotic regimen.…”

“…Additionally, rupture of renal cortical abscess or renal carbuncle can result in the formation of PNA [2] . As a result of its anatomical location and potential to spread, RA is potentially lethal and the prognosis can be poor, especially in immunosuppressed and cache ctic patients [1,4] . PNA originates from hematogenous dissemination, and often has an acute presentation with pain and high spiking temperatures [2] , while in most cases, PNA is notoriously silent clinically [2,3] , thereby the diagnosis can be challenging [2] .…”

Spontaneous right-sided ureterocolic fistula: a rare complication of colonic diverticular disease

“…Diverticular ureterocolic fistulae are rare, with only nine previous cases reported 1. They are usually related to previous operations and affect the left ureter due to its proximity to the sigmoid colon 2. In the absence of a non-functioning infected kidney, it is recommended to resect the diseased colon with no manipulation of the urinary system (eg, nephroureterectomy) 2.…”