Abstract
IntroductionThe Fontan procedure is an intervention that helps to correct single ventricle physiology. There are many known long-term complications of 'Fontan physiology'. However, the occurrence of renal abscess in such patients has not yet been reported in the literature. The first generation of adults has now undergone the procedure and it is necessary to be aware of the long-term outcomes and complications associated with it.Case presentationWe report the case of a 22-year-old South Indian man who had developed a staphylococcal renal abscess against a background of xanthogranulomatous pyelonephritis, nine years after Fontan surgery. He presented to our hospital with a high-grade fever of 25-days duration but with no other symptoms. Physical examination identified costovertebral angle tenderness and pedal edema. An ultrasound scan revealed a mass in his left kidney. The results of a computed tomography scan were consistent with a renal abscess. Despite treatment with the appropriate parenteral antibiotics, there was no change in the size of the abscess and a left nephrectomy was performed as a curative procedure.ConclusionsThe learning points here are manifold. It is important to be aware of the possibility of renal abscess in a post-procedural patient. The early diagnosis of a septic focus in the kidneymay help to prevent the rare outcome of nephrectomy.
Highlights
The Fontan procedure is an intervention that helps to correct single ventricle physiology
Case presentation: We report the case of a 22-year-old South Indian man who had developed a staphylococcal renal abscess against a background of xanthogranulomatous pyelonephritis, nine years after Fontan surgery
Despite treatment with the appropriate parenteral antibiotics, there was no change in the size of the abscess and a left nephrectomy was performed as a curative procedure
Summary
Fontan surgery is a form of definitive palliation. It was first described in 1971 by Fontan and Baudet as a procedure for “physiological pulmonary blood flow restoration, with suppression of right and left blood mixing” [1]. We describe the case of a man with double outlet right ventricle and severe pulmonary stenosis who underwent a fenestrated Fontan procedure at the age of 13 He developed a left renal abscess nine years after the procedure. Case presentation A 22-year-old South Indian man with a previous history of Fontan surgery at the age of 13 for double outlet right ventricle with severe pulmonary stenosis and straddling tricuspid valve presented with a spiking high-grade fever of 25-day duration. He had no history of cough, ear discharge, respiratory infection, dysuria, diarrhea, gastrointestinal distress or vomiting.
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