Mohayuddin Nazim, Nathaniel Eemaz, Obaid Bakhtawar, James Aimen, Ikram Jibran, Zahid Ayesha
Rehman Medical Institute, Peshawar, Pakistan.
Rehman Medical College, Department of Medical Research, Pakistan.
Int J Surg Case Rep. 2024 Dec;125:110482. doi: 10.1016/j.ijscr.2024.110482. Epub 2024 Oct 19.
This case report details a rare instance of a renal jejunal fistula accompanied by tuberculosis (TB) and parasitic infestation in a pediatric patient. It adds to the limited literature on renal fistulas involving the jejunum, particularly those compounded by infectious diseases, highlighting the diagnostic and therapeutic challenges in managing such complex cases.
The patient initially presented with flank pain, a discharging sinus in the left flank region, cough, and general malaise, alongside symptoms of anemia. Clinical examination and diagnostics unveiled a non-functioning left kidney with multiple calculi and signs of severe pyelonephritis. However, surgery revealed an unexpected twist-a renal jejunal fistula with worm infestation.
The main diagnoses included a renal jejunal fistula, tuberculosis, and parasitic infestation. The patient underwent a left nephrectomy to remove the affected kidney, and the fistula was repaired. Postoperative care involved TB treatment and deworming. The case underscored the necessity of a comprehensive diagnostic approach and readiness for unexpected intraoperative findings.
This case highlights the importance of considering infectious diseases in the differential diagnosis of unusual renal or gastrointestinal symptoms, especially in pediatric patients from endemic regions. It demonstrates the necessity of interdisciplinary collaboration in managing rare and complex medical conditions and stresses the need for follow-up to assess long-term outcomes, which was limited in this case due to the patient's non-attendance at scheduled visits.
本病例报告详细描述了一名儿科患者罕见的肾空肠瘘合并结核病(TB)和寄生虫感染的情况。它补充了关于累及空肠的肾瘘,特别是那些合并传染病的有限文献,突出了处理此类复杂病例时的诊断和治疗挑战。
患者最初表现为胁腹痛、左胁腹区域有排液窦道、咳嗽和全身不适,同时伴有贫血症状。临床检查和诊断显示左肾无功能,伴有多发结石及严重肾盂肾炎迹象。然而,手术发现了一个意外情况——伴有蠕虫感染的肾空肠瘘。
主要诊断包括肾空肠瘘、结核病和寄生虫感染。患者接受了左肾切除术以切除患肾,并修复了瘘管。术后护理包括结核病治疗和驱虫。该病例强调了全面诊断方法的必要性以及应对术中意外发现的准备。
本病例突出了在鉴别诊断不寻常的肾脏或胃肠道症状时考虑传染病的重要性,特别是在来自流行地区的儿科患者中。它证明了在管理罕见和复杂医疗状况时跨学科合作的必要性,并强调了随访以评估长期结果的必要性,在本病例中由于患者未按计划就诊,随访受限。