Year-end Sale % OFF 
Abstract
Renocolic fistula is a rare clinical finding that is most commonly iatrogenic after surgical intervention. Herein, we present a case of renocolic fistula secondary to xanthogranulomatous pyelonephritis (XGP) with a subtle presentation as anemia. A 40-year-old female was found to have a hemoglobin of 6.5 g/dL after presenting for worsening fatigue. A urinalysis was remarkable for numerous white blood cell (WBC), positive bacteria, and nitrite. As part of her anemia workup, an esophagogastroduodenoscopy (EGD) was done which was normal while a colonoscopy showed a fistula opening with surrounding nodularity close to the splenic flexure of the colon. A computed tomography (CT) scan of the abdomen and pelvis with contrast showed chronic left kidney pyelonephritis with multiple contiguous abscesses in the inferior left kidney in addition to a staghorn calculus concerning for XGP. The patient was started on antibiotics and underwent laparotomy with repair of the renocolic fistula, partial omentectomy, and left nephrectomy. She tolerated the surgery well and was discharged with a stable hemoglobin. XGP is a rare type of chronic pyelonephritis that is usually a result of chronic obstruction by an infected stone. Spontaneous renocolic fistulas are rare nowadays with the advancement in antibiotics and renal stones treatment.
Highlights
Xanthogranulomatous pyelonephritis (XGP) is an uncommon cause of chronic pyelonephritis arising from obstruction of the kidney by infected renal stones [1]
We report a case of renocolic fistula caused by XGP in a patient that presented without a flank pain
The presentation is usually similar to pyelonephritis, including flank pain, fever, and a unilateral renal mass palpated on physical examination [3]
Summary
Xanthogranulomatous pyelonephritis (XGP) is an uncommon cause of chronic pyelonephritis arising from obstruction of the kidney by infected renal stones [1]. Granulomatous tissue invades the kidney, and resultant lipid-laden macrophages destroy the renal tissue [2] These patients commonly present with flank pain, and a unilateral renal mass felt on the physical exam [3]. We report a case of renocolic fistula caused by XGP in a patient that presented without a flank pain. How to cite this article Numan L, Zamir H, Husainat N M, et al (June 19, 2019) Xanthogranulomatous Pyelonephritis Causing Renocolic Fistula Presenting as Symptomatic Anemia. Based on the colonoscopy findings and the new fever, a computed tomography (CT) scan of the abdomen and pelvis with contrast was performed and it revealed chronic left kidney pyelonephritis with multiple contiguous abscesses in the inferior left kidney with a staghorn calculus concerning for XGP; it showed the fistula between the left kidney and the splenic flexure of the colon (Figures 2-3).
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
