|Year : 2000 | Volume
| Issue : 1 | Page : 62-64
Jayashri S Pandya, Narendra Desai
Department of General Surgery, B.Y.L. Nair Hospital, Mumbai, India
Jayashri S Pandya
B\101, Gokul Monarch, Thakur Complex, Kandivli (East), Mumbai - 400 101
Source of Support: None, Conflict of Interest: None
Keywords: Colon; Fistula; Kidney.
|How to cite this article:|
Pandya JS, Desai N. Reno-colo-cutaneous fistula. Indian J Urol 2000;17:62-4
| Case Report|| |
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|| |
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.  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. 
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.  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|| |
|1.||Jose C et al. Nephro-intestinal fistula. Arch Surg 1968; 97: 609-615. |
|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. |
|3.||Robert P et al. Renocolic and Reno-colo-cutaneous fistula: report of 3 cases. J Urol 1965; 94: 520-527. |
|4.||Brown RB. Spontaneous nephrocolic fistula. BJU 1966; 38(5) 488-491. |
[Figure 1], [Figure 2]