Pyeloduodenal fistula: a review of the current literature.

PURPOSE

Pyeloduodenal fistula (PDF) is a communication between the renal pelvis and the duodenum. It is often secondary to other diseases. It is a rare condition and therefore infrequently described in the literature. The aim is to present a review of the current literature on PDF and to give an update of its aetiology, symptoms, investigations and treatments.

METHODS

Pubmed, Cochrane Library and Embase were used to search for existing literature in English and Scandinavian languages with available abstracts in the period Jan 2000-Dec 2023.

RESULTS

No meta-analysis or reviews were found. In total, 24 original articles were found, including 25 cases all in all of both traumatic and spontaneous pyeloduodenal fistulas. Only four cases (15%) represented traumatic pyeloduodenal fistulas, and all of the spontaneous cases involved the right kidney and occurred due to calculi and pyonephrosis in 81% and 76% of the cases, respectively. Fever and flank pain were reported in 67% and 57% of the cases, respectively. Diagnosis was done by a CT urography or antegrade pyelography in 80% of the cases. More than 50% of all cases were managed by nephrectomy. Total parenteral nutrition (TPN) was administered alongside the nephrectomy in 28% of all cases.

CONCLUSION

A pyeloduodenal fistula often involves the right kidney and often occurs as a result of chronic renal inflammatory disease. The fistulas are most efficiently diagnosed with a CT scanning with contrast or retrograde pyelography. The most frequently used management of pyeloduodenal fistula is nephrectomy after closure of the duodenum with somatostatin and TPN.