A fistulous communication between the kidney and colon constitutes an exceedingly rare clinical entity, being referred to only casually in the average textbook of urology. Despite the fact that Hippocrates first made mention of this condition, Mertz (1), in 1931, succeeded in collecting only 26 cases over the intervening centuries. Since the excellent clinical and anatomical review of the subject by Vermooten and McKeown (2), 12 additional cases have appeared in the literature. The most recent, and by far the most unique, recorded by Markowitz and Katz (3), was a fistulous connection between the lower pole of a double kidney and the colon. Careful analysis of the literature does not tend to indicate an increased frequency of occurrence, but rather an earlier recognition of chronic kidney disease by improved diagnostic procedures and proper surgical management. The first thorough investigation of renocolic fistula was done by Rayer (4), who believed that a chronic infection of the kidney produced the initial lesion, the adjacent colon becoming attached by fibrous adhesions with subsequent ulceration and fistula formation. To date, no instance of the condition has been reported as a result of a primary bowel lesion. The investigations of Wesson (5), Ratliff and Barnes (6), and Higgins and Hicken (7), show fistula formation to be incident to a chronic suppurative process of the kidney with an associated perinephritis or perinephric abscess. Ratliff also points out that tuberculosis was the least frequently encountered causative agent, occurring only five times in 37 cases reviewed, while renal calculi accounted for 14 cases and 18 were collectively listed as of inflammatory origin. The outstanding symptoms of renocolic fistula are chills and fever, renal colic, and tumor in the flank, which disappears with dramatic suddenness following perforation and evacuation of pus into the bowel. Except in a few of the early cases which were discovered at necropsy, the diagnosis has been made by urographic methods. Hirsch and Bass (8) are of the opinion that the lesion may go undiagnosed unless retrograde studies are made. Wesson (5) and Feldman (9) have each diagnosed a case with the aid of a barium enema. Case History A 42-year-old Austrian-born housewife was admitted to the hospital because of intermittent pain in the chest. Approximately nine months prior to admission, without preceding injury, she experienced a dull aching pain in the lower left chest, which was not aggravated by deep breathing. She denied cough, hemoptysis, or dyspnea, but gave a history of associated high fever with chills and night sweats. A local physician treated her for “pleurisy,” and the symptoms gradually subsided. A month later, the pain recurred, but in a more disabling manner, and failed to respond to the therapeutic measures previously administered. One evening a diarrhea developed, which was followed by marked weakness and the patient fainted.
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May 1, 1946
J E Miller 
