Jacinto Cesar Karunungan, Lim Michael Geoffrey Lee, Lopez Marc Paul Jose, Serrano Dennis Pestano
Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
BMJ Case Rep. 2023 Jan 18;16(1):e249351. doi: 10.1136/bcr-2022-249351.
Fistula formation between the kidney, colon and the skin is an extremely rare complication arising from renal infections secondary to renal stone formation. During the 1980s, reports of nephrocolic fistulas, with or without involvement of the skin, were commonly caused by genitourinary tuberculosis. Due to improvements in diagnosis and specifically the development of anti-Koch's therapy, the incidence of nephrocolic or nephrocolocutaneous fistulas has become uncommon especially in developed countries.We report a case of a patient residing in a developing country, presenting with a 20-year history of a left flank lesion extruding minimal purulent output daily. He was seen at the emergency department due to weakness and was managed as a case of urosepsis. Contrast-enhanced CT scan and fistulogram showed a staghorn calculus in the left kidney with connections to the descending colon and skin. The patient eventually underwent a left hemicolectomy with en bloc excision of the kidney and fistula tract.
肾、结肠与皮肤之间形成瘘管是肾结石形成继发肾感染引起的一种极其罕见的并发症。在20世纪80年代，有或无皮肤累及的肾结肠瘘报告通常由泌尿生殖系统结核引起。由于诊断方法的改进，特别是抗结核治疗的发展，肾结肠瘘或肾结肠皮肤瘘的发病率已变得不常见，尤其是在发达国家。我们报告一例居住在发展中国家的患者，有20年左侧腰部病变史，每天有少量脓性分泌物排出。他因虚弱到急诊科就诊，被作为尿脓毒症病例处理。增强CT扫描和瘘管造影显示左肾有鹿角形结石，与降结肠和皮肤相连。该患者最终接受了左半结肠切除术，同时整块切除肾脏和瘘管。
