Ureteroiliac fistula secondary to radiotherapy in a patient with single renal metastasis of colon adenocarcinoma

Abstract

E146Ureteroiliac fistula secondary to radiotherapy in a patient with single renal metastasis of colon adenocarcinoma Cite as: Can Urol Assoc J 2013;7:E146-E149. http://dx.doi.org/10.5489/cuaj.259 AbstractWe report the case of a 61-year-old man diagnosed in 2001 with rectal cancer (stage T3N1M0). The patient was treated with surgery, adjuvant chemotherapy and radiotherapy. In 2009, he was admitted to the urology department with a complaint of right hemiabdominal pain. The anatomopathological investigation reported renal metastasis of colon adenocarcinoma. After surgery, he received adjuvant chemotherapy. No tumour recurrence or metastasis was reported at the 22-month follow-up. IntroductionThe kidney is the fifth most frequent site of metastasis in tumours. However, secondary neoplasm only accounts for 3% of renal malignant disease. Ureteroiliac fistulas are infrequent but serious conditions, with a mortality rate that ranges from 7% to 23%. We report these two rare conditions in a single patient. Case reportA 61-year-old man was diagnosed in 2001 with moderately differentiated rectal cancer (stage T3N1M0). The patient was treated by surgery, adjuvant chemotherapy and radiotherapy. He was under medical control until September 2003, when the disease progressed to the level of colorectal anastomosis. This time, the right ureter was also involved with disease, the tumour was based on the right iliac vessels and infiltrated small intestine. Therapeutic approach consisted in surgery and radiotherapy in the tumoural area, followed by adjuvant chemotherapy.In 2009, he was referred to the department of urology with complaints of right hemiabdominal pain for 2 days. He also presented with asthenia, dyspnea with minimal efforts and vomiting on two occasions before his admission to hospital.Physical examination was only positive for right hemiabdominal tenderness and decreased bowel sounds. He was afebrile. Blood test showed anemia (hemoglobine levels: 7.4 g/dL) and hyperbilirrubinemia with cholestatic pattern. Creatinine levels were 1.7 mg/dL. Abdominal x-ray did not revealed any abnormalities. One 20-cm heterogeneous lesion in the right hemiabdomen, a grade IV/IV ureteral hydronephrosis in the right urinary tract and grade II/IV in the left side were seen on the abdominal ultrasound. These findings were correlated with the impaired renal function.A computed tomography (CT) scan showed a small right pleural effusion, which confirmed bilateral ureteral hydronephrosis with a kidney size of 20 × 17 × 23 cm. The radiologist report concluded a right ureteral hydronephrosis grade IV/IV, with large renal and urinary tract dilatation and compressive effect on the liver, the small intestine and the colon (Fig. 1, Fig. 2).We catheterized the left urinary tract which resolved the hydronephrosis. After performing this procedure on the right side, we found blood circulating again. This sign was also observed when we tried to place a nephrostomy in the right kidney.A renal arteriography revealed an irregular lesion in the middle zone of...

Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis

“…25 Gastric carcinoma patients have a frequency of 11.1% to 15.1% of cases with renal metastases. 23,27,57 Colorectal tumors [58][59][60][61][62][63] represent 4.7% to 22% of cases with renal metastases. 4,6,27 In an autopsy series, metastases to the kidney from a colorectal primary was found in only 2.7% of cases and was frequently associated with widespread metastases.…”