Fístula enterocutánea como complicación de nefrolitotomía percutánea en pacientes con cirugía bariátrica previa: presentación del caso y revisión de la literatura

Abstract

Enterocutaneous fistula is a rare complication after percutaneous nephrolithotomy. Some situations are risk factors for it to occur, such as horseshoe kidney, retrorenal colon and chronic colonic dilation by several factors, among them late postoperative time after yeyunoileal bypass in morbid obesity treatment. 35-year-old female patient with a 2.5 cm calculus in the right renal pelvis. Late postoperative time after bariatric surgery using duodenal switch technique, and 55 kg lost till present. She undergone percutaneous nephrolithotomy (PCNL) with two punctures, one in the lower calyx, lost during dilation, and other in the upper calyx through which surgery was successfully carried out. During immediate postoperative time it enteric secretions were observed through the lower chalice puncture. Once the intraperitoneal lesion was removed, decision for conservative treatment was taken with fistula drainage, broadspectrum antibiotic therapy, fasting and total parenteral nutrition. The fistula debt ceased in the 8th postoperative (PO) day, when drain and nephrostomy tube were withdrawn and patient was discharged from the hospital on 10th PO day. On ambulatory follow up the patient is in good conditions. One case of enterocutaneous fistula after PNL presented in a patient in late postoperative time after yeyunoileal bypass. She was successfully treated by conservative therapy. Several authors point to chronic colonic distention and to great loss of retroperitoneal fat as causes for the increase of inadvertent colonic punctures in percutaneous renal access. The risk of complications with enterocutaneous fistula is significantly higher during the postoperatory in patients of bariatric surgery than in others.