Pyelo-Duodenal Fistula

Abstract

SUMMARY A case of spontaneous pyelo‐duodenal fistula is described and is the twenty‐fourth so far recorded in the Iiterature. It is the first case to have survived without surgical ablation of the fistula immediately following the diagnosis. The symptomatology and treatment of the condition are briefly reviewed. Ail previously reported cases are listed in table form to correlate the setiology, management and prognosis. Analysis of the cases suggests that although definitive surgery is the treatment of choice, a more critical evaluation of the rationale is now required. Antibiotic therapy has removed tuberculosis from the aetiology and the prognosis for the non‐malignant pyelo‐duodenal fistula is excellent.

Pyeloduodenal fistula diagnosed with technetium-99m scintigraphy and managed with a conservative strategy

“…Pyeloduodenal fistula, first described in 1841 by Rayer and Campaignac, is an uncommon clinical entity. 6 7 The anatomic proximity of the right kidney with the second portion of the duodenum enables fistula formation in the setting of renal inflammatory conditions, including nephrolithiasis or pyelonephritis. Malignant aetiologies of pyeloduodenal fistula include urothelial carcinoma, renal transitional cell carcinoma and nephrolithiasis-related squamous cell carcinoma and adenocarcinoma.…”

Severe anemia and melena caused by pyeloduodenal fistula due to renal stone-associated squamous cell carcinoma

“…1,2 Only eight cases of pyeloduodenal fistulas were due to upper tract malignancy (Table-I). [2][3][4][5][6][7][8][9] Most pyeloduodenal fistulas occur because of a chronic renal inflammatory disease, such as pyonephrosis, perinephritis, renal calculi, xanthogranulomatous pyelonephritis, or tuberculosis.…”

“…In the review by McEwan, 1 it was pointed out that an insidious and progressive asymptomatic pyelonephritis was an attendant clinical condition, but the gastrointestinal symptoms should be considered an important clue for diagnosis. There are several reviews that have reported that diarrhea, nausea, vomiting, epigastric pain, dyspepsia, general malaise and weight loss are common symptoms, but there was only one reported case of presentation with melena.…”

Duodenal and Common Bile Duct Obstruction with a Pyelo‐duodenal Fistula caused by Renal Calculous Pyonephrosis

“…Organic obstruction of the duodenum is rare and the combination of duodenal and common bile duct obstruction caused by renal sepsis and associated with a pyelo-duodenal fistula has not been reported previoudy. McEwan (1968) reviewed 24 cases of spontaneous pyelo-duodenal fistula in the world literature and discussed aetiology and nianagement. Patients usually present with nonspecific gastro-intestinal symptonis which :trc associated with chronic renal sepsis and a l s o on occasions the flow of urine into thc duodenum gives rise to a hyperchloraemic acidosis (Boggs, Blundon and Davis.…”