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

Abstract

We present a case of pyeloduodenal fistula in an 89-year-old woman with history of nephrolithiasis and recurrent urinary tract infection (UTI) who presented to the emergency department with back pain. CT revealed a malrotated right kidney with a large renal stone and possible fistulous connection between the second portion of the duodenum and the right renal collecting system. Technetium-99m scintigraphy confirmed presence of the fistula. The patient declined intervention and was discharged from the hospital with oral antibiotic suppressive therapy. The patient remained clinically stable at time of follow-up 3 months later. Spontaneous pyeloduodenal fistula is an aetiology of recurrent upper or lower UTIs or persistent bacteriuria though uncommonly recognised. Diagnosis may be achieved using several modalities, including technetium-99m scintigraphy. Nephrectomy and primary fistula closure has traditionally been the treatment of choice for this condition; however, conservative management is an option for patients with intact renal function.

Reno-duodenal fistula as a complication of longstanding renal tract calculus

“…Case reports have detailed conservatively treated reno-duodenal fistulae using IV antibiotics with urinary diversion through either ureteric stent insertion or nephrostomy. This has only been demonstrated in cases where the affected kidney has intact renal function and so is not applicable in our case (5).…”

“…They are typically identified during CT scanning, with a variety of imaging modalities used to confirm the presence of the fistula tract described in the literature including antegrade and retrograde pyelography, contrast-enhanced CT, OGD and 99m Tc scintigraphy have all been successful in identifying and mapping tracts in various case reports (5).…”

Uretero-duodenal Fistula as a Result from Ureteropelvic Junction Obstruction Correction: Case Report

“…The diagnosis of uretero-duodenal fistula generally required confirmation of connection between from urinary tract and gastrointestinal tract. 6 Recent evidence mentioned RP, AP or contrast enhanced CT as the diagnostics of choice. [6][7][8] The ideal treatment of ureteroduodenal fistula remains controversial.…”

“…6 Recent evidence mentioned RP, AP or contrast enhanced CT as the diagnostics of choice. [6][7][8] The ideal treatment of ureteroduodenal fistula remains controversial. In generally, tradi-tional management is nephrectomy and primary closure of fistula.…”

Successful Endoscopic Closure of Pyeloduodenal Fistula Using an Over-the-Scope Clip

“…Although there is no definitively known amount of time to allow for spontaneous PDF resolution, there are case reports of patients being monitored for signs of clinical improvement for 3 months. 11 At the time of the esophagogastroduodenoscopy, conservative management with nephrostomy tube placement and ureteral stenting had failed for a little over 3 months. There was also concern that small particles of retained stone within the fistula would prevent spontaneous closure.…”