A case of Xanthogranulomatous pyelonephritis with spontaneous renocolic fistula

Abstract

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.

A Rare Case of Xanthogranulomatous Pyelonephritis with Spontaneous Renocolic Fistula and IVC Thrombosis

“…Renocolic fistulae are an uncommon complication of XGPN with no large case series in the literature to the best of our knowledge [13][14][15]. Anatomically, the left colon's posterior wall, devoid of serosa, is directly opposite the anterior surface of the left kidney.…”

“…Our choice to perform a defunctioning temporary ileostomy to exclude and protect the renocolic fistula and delay nephrectomy and colonic resection was conditioned by the patient's very poor general status; the patient was admitted with sepsis, severe anemia, and pulmonary embolism and also needed placement of an inferior vena cava filter because of extensive thrombosis. e designation of XGPN as a separate entity is important because it is not only often recognizable as a clinicopathological syndrome but also unique among the inflammatory conditions of the kidney in closely mimicking Case Reports in Nephrology the clinical, radiological, and even histological features of renal cell carcinoma [13]. Prognosis largely depends on the underlying etiology, renal failure stage, and the patient's general status.…”

A Case of Xanthogranulomatous Pyelonephritis Associated with Renoduodenal Fistula

“…Among Stage III disease, fistula formation is known to be associated with XGP, with reports of fistulas forming to the skin, bronchi, psoas muscle, and intestine [11, 12]. These are likely due to chronic inflammation leading to adherence and subsequent perforation of renal tissue to adjacent structures, though it is also possible that initial fistula formation leads to chronic inflammation and subsequent XGP.…”

“…Depending on the case series, fistulas may be found in up to 8% of cases of XGP. Among intestinal fistulas, renocolic fistulas are by far the most frequent, likely due to the abutment of the naked posterior wall of the left colon to the anterior surface of the left kidney [12]. To our knowledge, there is only one prior report of XGP associated with a renoduodenal fistula [5].…”

Xanthogranulomatous Pyelonephritis: Synchronous Upper and Lower Gastrointestinal Bleed

“…Fistulas connecting the kidney to the colon, jejunum, duodenum, bronchus, diaphragm, thorax, psoas muscle, and skin were reported. 4-12…”