Korean J Gastroenterol.  2018 Apr;71(4):229-233. 10.4166/kjg.2018.71.4.229.

Pyeloduodenal Fistula Caused by Renal Calculi

• Park BK
• Kim GH

• KMID: 2409892
• DOI: http://doi.org/10.4166/kjg.2018.71.4.229

Abstract

A fistula between the renal pelvis and duodenum (pyeloduodenal fistula) is very rare. It can occur spontaneously or after trauma to one of these organs. A spontaneous pyeloduodenal fistula is usually caused by chronic inflammation, including reactions to foreign bodies, nephrolithiasis, benign and malignant neoplasms, as well as pyogenic infections. The main treatment to date has been surgery. We encountered one case of pyeloduodenal fistula found during an evaluation for abdominal discomfort in a 39-year-old female. Pyeloduodenal fistula was diagnosed by upper gastrointestinal endoscopy and abdominal computed tomography, and it was caused by direct invasion of nephrolithiasis. Surgical operation was recommended, but the patient refused. The patient has been free of symptoms for four years. Herein, we report an unusual case of pyeloduodenal fistula without surgical management and relevant literature review.

Keyword

Duodenum; Intestinal fistula; Kidney; Staghorn calculi

MeSH Terms

Adult
Duodenum
Endoscopy, Gastrointestinal
Female
Fistula*
Foreign Bodies
Humans
Inflammation
Intestinal Fistula
Kidney
Kidney Calculi*
Kidney Pelvis
Nephrolithiasis

Figure

• 

  Fig. 1. Serial endoscopic findings. (A) At endoscopy 8 years ago, a shallow ulcerative lesion with nodular change and convergence of mucosal folds is observed at the second portion of the duodenum. (B) Endoscopy taken 2 years ago reveals an improvement of previous ulcerative lesion, but convergence of mucosal folds seems to still exist. (C) Endoscopy at visit reveals a brownish stone at the center of converging mucosal folds, protruding from the outside into the duodenal lumen. (D) Follow-up endoscopy 4 years later reveals a subsided stone and closed fistula.

• 

  Fig. 2. Abdominal computed tomography. (A) In the right kidney, parenchymal calcification and staghorn calculi (arrow) are observed. The fragments of calculi invade into the duodenum (arrowhead). (B) There was a fistula between the second part of the duodenum and the right kidney. (C) On a coronal view, the fragments of calculi invading into the duodenum are clearly seen (arrow). (D) Follow-up computed tomography 4 years later reveals an improvement of calculi invasion of the duodenum.

Reference

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