Spontaneous uretero-sigmoid fistula secondary to calculus

Abstract

A 25-year-old man was referred to the urology department after a subacute history of left back pain, burning micturition associated with pneumaturia and fecaluria. Ultrasonography was performed showing hydronephrosis, and plain film radiography demonstrated a long vertical left pelvic calculi. Uro-computed tomography (CT) combined with a water enema CT showed a 10 cm long calculus with the cranial extremity fistulating the sigmoidal wall. Surgical treatment included left nephroureterectomy and sigmoidectomy with a colorectal anastomosis. Postoperative course was uneventful.

Fig. 1

Plain film radiography showing a long stick-shaped vertical calcification in the left pelvic area (white arrow). Notice the other calcified opacities upper in the left kidney (black arrow).

Fig. 2

Uro-computed tomography (CT) scans with water enema; (A) CT volume rendering scan at the delayed phase: non-functioning left kidney with multiple caliceal calculi; (B) multiplanar reformat CT scan showing the calculus presenting its cranial extremity in the sigmoidal lumen (arrow); (C) CT curved planar reformat in the axis of the left ureter showing a gas bubble (arrow) in the dilated ureter.

Fig. 3

Intraoperative view after nephrectomy and before sigmoidectomy. Colonic fistula is well-identified with the calculus.