Indian Journal of Urology
CASE REPORT
Year
: 2000  |  Volume : 17  |  Issue : 1  |  Page : 64--65

Spontaneous reno-colic fistula


Rakesh Parasher, K Sasidharan 
 Division of Urology, Kasturba Medical College, Manipal, India

Correspondence Address:
K Sasidharan
Division of Urology, Kasturba Medical College, Manipal - 576 119
India




How to cite this article:
Parasher R, Sasidharan K. Spontaneous reno-colic fistula.Indian J Urol 2000;17:64-65


How to cite this URL:
Parasher R, Sasidharan K. Spontaneous reno-colic fistula. Indian J Urol [serial online] 2000 [cited 2020 Sep 21 ];17:64-65
Available from: http://www.indianjurol.com/text.asp?2000/17/1/64/41026


Full Text

 Introduction



Reno-colic fistula occurs rarely and was first described in 460 B.C. by Hippocrates. Since that time about 120 cases have been reported. The occurrence of this condi­tion has in recent times declined due to prompt treatment of renal pathologies before the stage of fistula formation. We herein present a case of reno-colic fistula secondary to renal tuberculosis.

 Case Report



A 42-year-old female presented with recurrent left flank pain, diarrhoea and episodic low-grade fever of 6 months duration. There was preceding history of pulmonary tu­berculosis.

On evaluation she was found to have mild anaemia and elevated ESR. Urine culture grew E.coli Serum creatinine and blood urea were within normal limits.

An intravenous urogram disclosed a poorly visualised left kidney and normal right kidney. Left retrograde ure­terogram showed an irregular and marginally dilated pelvicalyceal system in a relatively contracted kidney. The ureter was unremarkable. Her history of diarrhoea man­dated a Barium study and colonoscopy. During the former study barium was seen entering the left pelvicalyceal sys­tem [Figure 1], and the post evacuation film showed persist­ence of barium in the kidney [Figure 2]. The colonoscopy disclosed a puchered and spastic segment close to the splenic flexure indicating the site of the fistula.

The patient underwent left nephrectomy along with seg­mental resection of colon with subsequent luminal resto­ration with colo-colic anastomosis. Her postoperative period was uneventful and she continues to remain well till date.

The histopathology of the composite specimen of left kidney and colonic segment was in consonance with re­nal tuberculosis.

 Discussion



Among reported cases of reno-alimentary fistulas in lit­erature reno-colic fistulas were most common. Leading causes of such fistulization are chronic renal diseases (spontaneous fistulas) and severe renal trauma (penetrating and non-penetrating. [1],[2],[3] In the current setting PCNL can also lead to reno-colic fistulas. [5] Other rare causes are diverticular and inflammatory bowel disease and even carcinoma. [4] Tuberculosis remains the principal cause of spontaneous colorenal fistulas. The involved kidney is non­functioning and hence recommended treatment is nephrec­tomy with excision of the involved colonic segment and subsequent luminal restoration with end-to-end anastomo­sis.

We concede that in recent times prompt multidrug tuber­cular chemotherapy has significantly retarded the inci­dence of spontaneous reno-colic fistula due to the disease. However, renal tuberculosis being endemic in our coun­try, we can not dismiss altogether an insidious develop­ment of such fistulas in non-functioning retained kidneys.

References

1Bissada NK, Cole AT, Fried FA. Reno-alimentary fistula: An un­usual urological problem. J Urol 1973: 110: 273.
2Arthur GW, Morris DG. Reno-alimentary fistula. Br J Surg 1966: 53: 396.
3Melvin WS, Burak WE, Flowers JL, Donald SG. Reno-colic fistula following primary repair of the colon: a case report. J Trauma 1993: Vol 35 No. 6: 956.
4Burst RW Jr, Morgan AL. Reno-colic fistula secondary to carci­noma of the colon. J. Urol 1974; 111: 439.
5Neustein P, Barbaric ZL, Kaufman JJ. Nephrocolic fistula: A com­plication of percutaneous nephrolithotomy. J Urol 1986; 135: 571.