Incidental renocolic fistula with xanthogranulomatous pyelonephritis

Abstract

Introduction: We report the case of a 66-year-old female undergoing elective nephrectomy for a non-functioning kidney in whom an incidental renocolic fistula was detected.

Presentation of case: She presented with recurrent urinary tract infections and left flank pain. Investigations revealed a nonfunctioning left kidney with a large staghorn calculus and features suggestive of xanthogranulomatous pyelonephritis (XPG). At nephrectomy, an incidental renocolic fistula was found and excised.

Discussion: XGP is a rare, chronic inflammatory disorder of the kidney characterized by a destructive mass invading the renal parenchyma. Renocolic fistulae complicating XGP are uncommon and not widely reported in the literature.

Conclusion: Herein, we describe a case of XGP with renocolic fistula formation, its management and a review of the literature.

Fig. 1

A non-contrast CT demonstrating a markedly thinned cortex with pernephric stranding and a large calculus. Features are suggestive of xanthogranulomatous pyelonephritis.

Fig. 2

Arrow demonstrating bowel adherent to antermedial renal cortex.

Fig. 3

Abnormal kidney with thin cortex and multiple stones within the collecting system (arrow). Extensive pus present. Forceps demonstrates the fistulous tract through the cortex.