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Calyceal Cutaneous Fistula
Connor Deal
February 2013
• HPI: 73 year old female with recurrent right flank abscess s/p drainage (3/2012, 9/2012) who presents with further work-up of recurrent abscess – suspicion for enterocutaneous fistula. No fevers/chills.
• PMH: HTN, CKD, Nephrolithiasis, DVT (2/2012), DM
• PSH: Kidney stone removal (1969), Right flank abscess drainage (3/2012, 9/2012), av fistula placement (7/2012), ivc filter (2/2012)
• PE: Vitals: WNL; Gen:AOx3; Back:Guaze/Tegaderm over R-flank abscess with milky/yellowish purulent drainage. Slightly tender.
• Labs: BUN: 55; Bicarb: 15; Creat: 4.16; WBC 14.86
History
• We know there is an abscess.• Is there a fistula?
DDx
ACR Criteria for suspected abscess
TIMELINE
March 2012 drain R flank
abscess2/4/2013Admission
2/5/201312:20pm
Fluoroscopy
2/5/20132:30pm
Ultrasound
2/5/20139:14pm
CT Abdomen
2/6/2013IR Drainage
Sept 2012 drain R flank
abscess
Fluoro Sinogram Fistulogram GI tract only
-Prior to full injection of contrast
What is this?
5193023
Fluoro Sinogram Fistulogram GI tract only
5193023
5193549
CT Abdomen W/O IV contrast – Coronal View
5193549
CT Abdomen W/O IV contrast – Saggital View
Air bubble?
• IR drain placed by IR – 1 month duration• flagyl and levaquin – for diverticulitis• Followup• Future of kidney?
Outcome
• 65 yo female with right flank pain found to have complete right staghorn calculus with nephrocutaneous fistula.
• Fistula found by retrograde pyelogram which also confirmed the need for complete right nephrectomy.
Case Report (1990)
Figure 3: Right retrograde pyelogram shows the pelvic calcification outside the ureter and a fistulous tract between the renal pelvis and the skin.
• Charles JC. Nephrocutaneous fistula. J Natl Med Assoc. 1990;82 (8): 589-90. PMID PMC2626966
Reference