Pyeloduodenal Fistula Successfully Treated By Endoscopic Ligation without Surgical Nephrectomy: Case Report

Abstract

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.

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

“…Renoalimentary fistulae are usually treated by resection of the affected bowel segment and nephrectomy of the associated kidney 3 8 9. However the treatment of malignant renoalimentary fistulae is more complex.…”

Renoalimentary fistula: Case report of a renoduodenal fistula and systematic literature review

“…Literature review demonstrates that most patients with renoalimentary fistulae report a history of chronic complaints, typically involving the renal and GI systems, such as flank or epigastric pain, dyspepsia, fever, a palpable abdominal mass, voiding problems, and nausea/vomiting. 1 , 3 , 4 Less frequent symptoms include weakness/malaise, weight loss, diarrhea or constipation, and GI bleeding. 1 , 3 , 4 Laboratory investigation typically reveals an elevated white blood cell count, anemia, pyuria, and occasionally renal insufficiency.…”

“… 1 , 3 , 4 Less frequent symptoms include weakness/malaise, weight loss, diarrhea or constipation, and GI bleeding. 1 , 3 , 4 Laboratory investigation typically reveals an elevated white blood cell count, anemia, pyuria, and occasionally renal insufficiency. 3 Similarly, our patient acknowledged a history of vague flank pain for the preceding two months, and had laboratory results consistent with leukocytosis and urinary tract infection.…”

“…Diagnosis of renoalimentary fistulae most commonly occurs by radiologic imaging of the urinary system, with retrograde or anterograde (as was performed in our patient) pyelography most accurately identifying the fistulous connections. 3 , 4 Use of upper GI studies has also been reported. 3 , 4 Most renoduodenal fistulae involve the second part of the duodenum due to its relative immobility, lack of posterior peritoneal covering, and close contact with the anterior kidney.…”

The unusual endoscopic finding in a patient presenting with the chronic duodenal bulb ulcer complicated by hemorrhage

“…Наиболее частыми причинами формирования фистул являются мочекаменная бо-лезнь (МКБ) с развитием пиелонефрита, паранеф-рита, туберкулез, язва ДПК, киста почки, опухоли желудочно-кишечного тракта, травма (падение с высоты, автотравма, катетеризации мочеточника, инородные тела, оперативные вмешательства, огне-стрельные ранения). В то же время следует отме-тить, что около 65% спонтанных фистул развивается вследствие обструктивного пиелонефрита [4].…”