Raghavan Deepa, Vojjala Nikhil, Prabhu Rishab, Azar Ibrahim
Wayne State University School of Medicine.
Department of Internal Medicine Trinity Health Oakland Hospital.
J Brown Hosp Med. 2025 Jul 1;4(3):137804. doi: 10.56305/001c.137804. eCollection 2025.
Reno-duodenal fistulas are an extremely rare complication of radiotherapy in patients with metastatic lung cancer. Here we describe the case of a 60-year-old man with metastatic non-small cell lung cancer treated with chemoradiation who presented with fever, chills, and flank pain and was found to have septic shock with polymicrobial bacteremia and fungemia. Subsequent imaging showed evidence of a reno-duodenal fistula. After a failed attempt at endoscopic closure, the patient was not deemed a surgical candidate due to poor performance status and advanced metastatic disease and was transitioned to home hospice care. This report highlights the importance of considering reno-alimentary fistulization in the differential diagnosis of emphysematous pyelonephritis, especially in the setting of radiation therapy and malignancy.
肾十二指肠瘘是转移性肺癌患者放疗极为罕见的并发症。在此，我们描述一例60岁转移性非小细胞肺癌患者，接受放化疗后出现发热、寒战和侧腹痛，被发现患有伴有多种微生物菌血症和真菌血症的感染性休克。随后的影像学检查显示存在肾十二指肠瘘。在内镜闭合尝试失败后，由于患者身体状况差和晚期转移性疾病，不被认为是手术候选者，转而接受居家临终关怀。本报告强调了在气肿性肾盂肾炎的鉴别诊断中考虑肾消化道瘘形成的重要性，尤其是在放疗和恶性肿瘤背景下。
