RESUMEN

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.

RESUMEN

Xanthogranulomatous pyelonephritis is a rare and aggressive form of chronic pyelonephritis, it can occur at all age groups but is more common in women than in men, supposedly relating to the increased incidence of urinary tract infections and chronic nephrolithiasis in woman. Computed tomography (CT) findings are very helpful in making the correct diagnosis, but the definitive diagnosis is still based on histology, as there are many differential diagnoses such as renal cell carcinoma and renal tuberculosis. The complications of this type of pyelonephritis are due to the involvement of adjacent organs. The most frequent ones are Psoas abscess, perinephric abscess, and sepsis. Nephrocutaneous and renocolic fistulas are less common. We report a case of a 61-year-old male, who presented to emergency for left-sided lumbar pain for whom radiological investigations confirmed a renocolic fistula complicating xanthogranulomatous pyelonephritis. The diagnosis of XGP was proven by histopathological examination of the nephrectomy specimen slides, but there was also association with an underlying malignant squamous differentiation consistent with urothelial carcinoma, which was not evident on CT. XGP is a rare variant of chronic pyelonephritis with known imaging features. The treatment of choice is nephrectomy and histopathological examination is required for final diagnosis, as there may be associated renal malignancy.

RESUMEN

Double J stents are used commonly in modern urology and the occurrence of complications is rare. Here we report a case of renocolic fistula due to a misplaced ureteral stent, not so far reported in the literature. Early diagnosis and intervention like ureteral stent exchange in our case, can avoid the need for nephrectomy.

RESUMEN

Renocolic fistula is a rare clinical finding that is most commonly iatrogenic after surgical intervention. Herein, we present a case of renocolic fistula secondary to xanthogranulomatous pyelonephritis (XGP) with a subtle presentation as anemia. A 40-year-old female was found to have a hemoglobin of 6.5 g/dL after presenting for worsening fatigue. A urinalysis was remarkable for numerous white blood cell (WBC), positive bacteria, and nitrite. As part of her anemia workup, an esophagogastroduodenoscopy (EGD) was done which was normal while a colonoscopy showed a fistula opening with surrounding nodularity close to the splenic flexure of the colon. A computed tomography (CT) scan of the abdomen and pelvis with contrast showed chronic left kidney pyelonephritis with multiple contiguous abscesses in the inferior left kidney in addition to a staghorn calculus concerning for XGP. The patient was started on antibiotics and underwent laparotomy with repair of the renocolic fistula, partial omentectomy, and left nephrectomy. She tolerated the surgery well and was discharged with a stable hemoglobin. XGP is a rare type of chronic pyelonephritis that is usually a result of chronic obstruction by an infected stone. Spontaneous renocolic fistulas are rare nowadays with the advancement in antibiotics and renal stones treatment.

RESUMEN

We present a rare case of retroperitoneal rupture of an infected renal cyst secondary to a renocolic fistula in a patient with autosomal dominant polycystic kidney disease (ADPKD). Intraperitoneal rupture of infected cysts in ADPKD resulting in peritonitis has been described, but to our knowledge, this is the first reported case of retroperitoneal rupture. Cyst infections are a common complication of ADPKD and are difficult to treat, potentially leading to sepsis and death.

RESUMEN

•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.

RESUMEN

Xanthogranulomatous pyelonephritis (XGP) is an uncommon inflammatory disease of the kidney 1. Diffuse XGP is a rare condition which may spread into the pelvic cavity leading to fatal complications from a psoas muscle abscess and/or renocolic fistula 2. In diffuse type, nephrectomy and excision of the fistula is the recommended treatment.

RESUMEN

Xanthogranulomatous pyelonephritis (XGPN) is a rare clinicopathological syndrome that is unique among the various inflammatory conditions of the kidney, and it closely mimics renal cell carcinoma, both clinically and radiologically. Approximately one third of XGPN cases have associated complications, such as abscess and fistulas, although the latter is much less common. Spontaneous renocolic fistulas of non-tubercular origin are also rare, especially in Asia. Fistula or deep sinus formation as a complication of XGPN is a rare clinical condition. Currently, only approximately 10 such cases (including our case) have been reported in the literature. We present one such case of spontaneous nephrocolic fistula complicating XGPN. Ultrasonography, an intravenous urogram, retrograde pyelogram, and computerized tomography aided in diagnosing the presence of a renocolic fistula. The treatment regimen of total nephrectomy with primary closure of the rent in the colon was adequate.

RESUMEN

A 76 year old woman with bloody stools and symptomatic anemia presented to the Emergency Department approximately 2 wk after computed tomography (CT)-guided cryoablation to a 4.5 cm renal cell carcinoma on her left posterior kidney. The patient was initially prepped for a colonoscopy to view possible causes of lower gastrointestinal bleeding. However, the patient had a CT with PO contrast that revealed a variation of a renoalimentary fistula. The patient was subsequently brought to the operating room, and it was discovered that a colo-renal fistula had formed, with transmural perforation of the posterior descending colon. A left nephrectomy, left colectomy with colostomy and Hartmann's pouch was performed.

RESUMEN

Renal injury inflicted by high-velocity missiles is serious because of the wide spread blast injury to tissue. Blast effect may lead to a secondary tissue necrosis with hemorrhage, fistula and infection. Recently we experienced one case of bilateral injury by gunshot complicated by renocolic fistula and intrarenal aneurysm. Management of delayed sequale of renal injury was presentedand discussed.

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