URETERODUODENAL FISTULA: A RARE COMPLICATION OF DUODENAL ULCER

Abstract

A 20-year-old man was admitted to the hospital for anemia. History was significant for duodenal ulcer 8 years before presentation with no regular treatment, 2 episodes of upper gastrointestinal tract bleeding and frequent attacks of right flank soreness for 2 years. Physical examination was unremarkable. Laboratory studies revealed only microcystic anemia. Right hydronephrosis was found incidentally on ultrasound. Excretory urography confirmed severe hydronephrosis and delayed excretion of the right kidney. Retrograde pyelography showed the duodenal mucosa coated with contrast medium (see figure). On exploration inflammation with severe adhesion was noted in the right kidney. The right upper ureter had fibrosis 2 inches long which appeared as a band below the ureteropelvic junction. There was an adhesion between the ureter and secondary portion of the duodenum. At dissection an obvious penetration defect of the secondary portion of the duodenum was found. The bowel defect was repaired and segmental ureterectomy with primary ureteroureterostomy over a 7Fr ureteral stent was performed. Convalescence was uneventful. The ureteral stent was removed 6 weeks postoperatively. Followup excretory urography demonstrated a normal caliber ureter and improvement in excretion of the right kidney.