Spontaneous nephrocolic fistula secondary to a staghorn calculus

Abstract

A 54-year-old woman-with no past surgical history-presented to the emergency department with an 8-day history of abdominal pain in the left Xank and diarrhea. Initially, the patient underwent an abdominal ultrasound that showed a lower pole kidney mass. Computed tomography was performed and revealed a fragmented staghorn calculus complicated with a xanthogranulomatous pyelonephritis in the left kidney (Fig. 1). The cleavage plane between the left kidney and the colon was undistinguished and a nephrocolic Wstula (arrows) was diagnosed. To conWrm this Wnding a barium enema was carried out: demonstrating passage of intravenous contrast from the colon to the kidney. Finally, the patient was taken to the surgery room where nephrectomy and left hemicolectomy were carried out.Few nephrointestinal Wstulae have been described in the literature, and the cases of spontaneous appearance of this condition are even scarce [1]. The most common cause of spontaneous nephrocolic Wstulae involves staghorn calculi [2]. These calculi are formed of a rapidly growing stone and are mainly composed of struvite-carbonate-apatite matrix. These stones are likely to cause great morbidity and mortality if not treated. Treatment frequently includes: percutaneous nephrolithotomy, followed by extracorporeal shock wave lithotripsy and/or Xexible ureteroscopy, and laser [3]. Imaging procedures-abdominal X-rays and computed tomography-are the best diagnostic tools to be used in this condition.

A Rare Case of Retroperitoneal Abscess Caused by Nephro-Colic Fistula Resulting from Staghorn Calculus

“…A common finding is the presence of a staghorn lithiasis located at the level of the fistula. Stones are usually composed of struvite-carbonate-apatite [ 3 ]. They increase morbidity and mortality when they are not treated [ 2 , 3 ].…”

“…Stones are usually composed of struvite-carbonate-apatite [ 3 ]. They increase morbidity and mortality when they are not treated [ 2 , 3 ]. No incidence is reported in the literature about NFC associated with a calculus.…”

“…Some studies report the calculus as the only etiology of a fistula [ 3 , 5 ]. Myers et al [ 10 ] already described in 1974 an increased risk of renal fistula in the event of radiological atrophy of the perirenal fat.…”

“…The treatments described in the literature are commonly antibiotics and surgery [ 2 , 3 , 6 , 8 ]. Due to the atypical chronology of these cases, the management varies hugely.…”

Use of an Over-the-Scope Clip for Closure of an Iatrogenic Nephrocolic Fistula Resulting From Cryoablative Therapy for Renal Cell Cancer of a Transplanted Renal Graft

“…Nephrocolic fistulae are the most common renodigestive fistulae and are typically the result of abdominal trauma or surgery, renal calculi, Crohn's disease, malignancy, or tuberculosis but rarely of thermal injury after RCC treatment. [5][6][7][8] Few reports described these fistulae resulting from percutaneous radiofrequency ablation and cryoablative techniques. 9 While applying cryotherapy for tumor ablation, the ice ball must extend at least 3 mm beyond the outer tumor margin to result in complete tumor cell death.…”