Primary spontaneous renocutaneous fistula

PRIMARY

SPONTANEOUS

RENOCUTANEOUS

FISTULA

S. R. BRYNIAK,

M.D.

From the Department Dalhousie University,

of Urology, St. John Campus, Halifax, Canada

ABSTRACT-A case of primary spontaneous renocutaneous calculus is presented and the literature reviewed.

Spontaneous renal fistulization to nearby viscera is not an uncommon phenomenon. However, a spontaneous cutaneous sinus from the kidney is rare, and in the few cases reported, they have developed in patients who had recent renal surgery. Only 1 case has been reported in the urologic literature of such a fistula developing spontaneously in a patient without prior history of surgical intervention. Herein is an additional case.

FIGURE

entering

516

fistula

associated

with

a staghorn

Case Report An eighty-three-year-old woman with a history of chronic left flank pain presented with a persisting draining sinus in the left costovertebra1 angle of four months’ duration. The intravenous pyelogram demonstrated a left dendritic renal calculus in a nonfunctioning kidney (Fig. lA, BI. A sinogram confirmed a tract extending from the skin to the calyceal system of

1.

(A) and (B) Staghorn calculus in nonfunctioning left kidney. (C) Sinogram demonstrating lower calyceal system (arrows) as well as pooling about upper pole of left kidney.

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the left kidney (Fig. 1C). A left nephrectomy was done, and her postoperative course was unremarkable. Both the cultures of the calculus and sinus discharge showed Proteus mirabilis with similar sensitivity antibiotic patterns. Comment Renal fistulas are usually a complication of chronic urinary tract infection usually with absces,s formation, surgical procedures on the kidney, renal trauma, and tumor. Such fistulas may develop between (1) the kidney and pleural cavity, lung or bronchus, which invariably a:re a consequence of inflammation; (2) the kidney and the bowel; and (3) the kidney and the skin.’ Over 100 instances of renoalimentary fistula have been reported. Most of these involve the stomach, duodenum, or adjacent disease is invariably a colon. ‘2-4The underlying pyonephrotic kidney which adheres to the alimentary structure and eventually ruptures into it creating a fistula. Renocutaneous fistulas on the other hand are rare. Most reported instances involve patients with prior renal sur-

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gery. Only one previous case of a primary spontaneous fistula has been reported in the North American literature, and this, like our case, was associated with a staghorn calculus.5 In both instances, partial or total nephrectomy resolved the problem. This case report not only adds to the literature a rare instance of primary spontaneous renocutaneous fistula, but also alludes to an additional complication of staghorn renal calculi.

St. John,

St. John Regional Hospital PO. Box 2100 New Brunswick, Canada E2L 4L2

References 1. Witten DM, Meyers GH Jr. and Utz DC: In: Emmet’s Clinical Urographl; 4th ed, Philadelphia. \1’B Saunders Co, 1977. 2. Bissada NK, Cole AT, and Fried FA: Reno-alimentary fistula: an unusual urological problem, J Ural 110: 273 (1973). 3. Dunn M, and Kirk D: Renogastric fistula: case report and review of the literature, ibid 109: 785 (1973). 4. Greene JE, Bucy JG, and Wise I,: Spontaneous pyeloduodenal and renocolic fistulas, South Med J 68: 641 (1975). 5. Das S, and Ching V: Nephrocutaneous sinus: a case report. J Ural 122: 232 (1979).