Indian Journal of Urology Users online:2227  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
CASE REPORT
Year : 2000  |  Volume : 17  |  Issue : 1  |  Page : 62-64
 

Reno-colo-cutaneous fistula


Department of General Surgery, B.Y.L. Nair Hospital, Mumbai, India

Correspondence Address:
Jayashri S Pandya
B\101, Gokul Monarch, Thakur Complex, Kandivli (East), Mumbai - 400 101
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

 

Keywords: Colon; Fistula; Kidney.


How to cite this article:
Pandya JS, Desai N. Reno-colo-cutaneous fistula. Indian J Urol 2000;17:62-4

How to cite this URL:
Pandya JS, Desai N. Reno-colo-cutaneous fistula. Indian J Urol [serial online] 2000 [cited 2019 May 20];17:62-4. Available from: http://www.indianjurol.com/text.asp?2000/17/1/62/41025



   Case Report Top


A 55-year-old woman was treated for paraspinal ab­scess on the left side by incision and drainage. Since then, she had a persistent intermittent discharging sinus for 12 months. Clinically, this was suspected to be tuberculous sinus, due to osteomyelitis of the spine or rib because of high prevalence of this disease in India. Accordingly, ra­diograph of the dorsolumbar spine and thorax were done. They revealed radio-opacity, suggestive of a staghorn cal­culus in the left kidney. There was no bony involvement. A sinogram [Figure 1] revealed a tract from the skin to the left renal pelvis with extravasation of the dye, partially also opacifying the descending colon. Ureter was not visu­alised. Intravenous pyelography showed a non-function­ing kidney on the left side.

Colonoscopy done initially was normal. However, when methylene blue was injected through the sinus tract, the dye appeared through a very minute opening in the de­scending colon. However no mucosal lesion was visual­ised. A CT scan [Figure 2] was performed to further delineate the local anatomy. This revealed a small shrunken and scarred left kidney with a staghorn calculus and surround­ing fibrosis. There was no evidence of any retroperitoneal perinephric pus pockets. On opacifying the tract, the dye was seen to be directly entering from the skin to renal pelvis to the descending colon. Patient was explored through left subcostal incision which included the sinus tract. Nephrocolic fistula was disconnected from the co­lon. Nephrectomy was carried out. The colon was closed in two layers. Postoperative recovery was uneventful. The patient is asymptomatic at 18 months' follow-up. Histopa­thology of the specimen was reported as chronic inflam­matory nephro-colo-cutaneous sinus. The kidney showed evidence of end-stage pyelonephritis.


   Comments Top


Nephro-colo-cutaneous fistula is a relatively rare dis­ease. In almost all cases, the origin of the fistula is from a diseased kidney. As reported in Western literature, tuber­culosis was the most common cause before 1936. Subse­quently noncalculus pyonephrosis was found to be the most common cause. [1] Occassionally, it may arise as a result of complication of surgery or instrumentation.

In majority of the cases, the kidney was found to be non-functional at the time of presentation. Nephrectomy with primary closure of the fistula was the treatment of choice. Occassionally in patients with complex fistula, proximal temporary colostomy needs to be carried out.­

Anatomically, the posterior wall of the left colon, which is devoid of serrosa, is directly apposed to the anterior surface of the adjacent kidney. The basic pathology is a chronic inflammatory process which first begins in the renal parenchyma. [3]

This permits slow adherence of the kidney to the colon, which provides for subsequent perforation and drainage of the infected urine and necrotic material resulting in chronic reno-colic fistula. The surrounding fibrosis pre­vents perinephric abscess formation. [4] However, if there is delay in this host tissue reaction, pockets of pus may form, which track down to open exteriorly resulting in cutane­ous reno-colic fistula.

 
   References Top

1.Jose C et al. Nephro-intestinal fistula. Arch Surg 1968; 97: 609­-615.  Back to cited text no. 1    
2.Rost G.S. Cooper D. Knouf C.E. Ferguson P. and McCrary. Ac­quired reno-colic fistula in remaining functioning kidney with re­covery: a case report. J Urol 1956: 75: 787.  Back to cited text no. 2    
3.Robert P et al. Renocolic and Reno-colo-cutaneous fistula: report of 3 cases. J Urol 1965; 94: 520-527.  Back to cited text no. 3    
4.Brown RB. Spontaneous nephrocolic fistula. BJU 1966; 38(5) 488-­491.  Back to cited text no. 4    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
Previous article Next article

    

 
   Search
 
   Next article
   Previous article 
   Table of Contents
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    [PDF Not available] *
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Case Report
    Comments
    References
    Article Figures

 Article Access Statistics
    Viewed1713    
    Printed51    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

HEALTHWARE INDIA