Unusual case of nephrocutaneous fistula – Our experience

Abstract

A rare case of nephrococutaneous fistula due to spontaneous expulsion of renal calculi is described. A 45-year-old man presented with urinary leakage from an ulcer over the left lumbar region for the last 3 months after a history of spontaneous expulsion of stones from this area. Ultrasonography abdomen revealed a small contracted kidney with multiple calculi in the kidney and renal pelvis, sinus tract from the lower pole of the left kidney with a ruptured calyceal calculus in the sinus tract. CT urography revealed a non excreting left kidney with multiple renal calculi, with hyperdense collection in the renal parenchyma extending to the subcutaneous tissue and left lung suggesting a xenthogranulomatous pyelonephritis (XGP). We performed a left-sided simple nephrectomy with excision of the fistulous tract. Histopathological examination revealed XGP. There have been a few case reports of XGP forming nephrocutaneous fistula in the back.

Clinicopathological spectrum of xanthogranulomatous pyelonephritis

“…Abscess formation (paranephric and psoas), fistula formation (renocutaneous and renocolonic), and sepsis are known complications. [19202122] In the present study, pyonephrosis and perinephric abscess were seen in 10 (25.0%) cases and 3 (7.5%) patients, respectively, and one case had nephrocutaneous fistula. Few patients may develop hypertension or hepatomegaly.…”

A rare case of spontaneous nephrocutaneous fistula

“…post tuberculosis of the urinary tract, xanthogranulomatous pyelonephritis and nephrolithiasis, although the reported cases are very rare. [1][2][3][4][5] Also, another cause of fistula formation is post trauma in which there is formation of urinoma which finds its way out through the path of least resistance i.e. through the posterior triangles of Grynfeldt and Petit.…”

“…The cases in the literature report occurrence of fistulae secondary to infections, tuberculosis and commonly secondary to surgery. [1][2][3][4][5] Most of the time, the required treatment is complete nephrectomy with excision of the nephrocutaneous fistula.…”

A surfacing staghorn: Spontaneous expulsion of a large renal calculus from a nephrocutaneous fistula

“…There are a small number of isolated case reports of spontaneous nephrocutaneous fistulae. The most frequently reported causes of spontaneous nephrocutaneous fistulae in the literature were staghorn calculi or multiple renal stones [10][11][12][13][14][15][16][17][18][19][20][21] associated with infection, particularly xanthogranulomatous pyelonephritis. 10,14,15,17 Other less common causes reported included ureteric stones, 22 renal tuberculosis 18,23 and renal replacement lipomatosis.…”

“…On review of the literature, many patients presented in a similar manner to our patient, with an intermittently discharging lesion from the flank where on examination one or multiple sinuses could be seen. [10][11][12][13][14][16][17][18][19][20][21][22][23] Some had subcutaneous swellings that had increased in size prior to rupturing. 17,21 Duration of symptoms varied from 3 months to 14 years.…”