Journal Article

A Rare Case of Xanthogranulomatous Pyelonephritis with Spontaneous Renocolic Fistula and IVC Thrombosis

Grande, Simona, Sforza, Daniele, Grande, Michele, Siragusa, Leandro, Ciancio Manuelli, Matteo, De Luca, Linda, Argirò, Renato, Nezzo, Marco, Villa, Massimo, Sensi, Bruno

2021

Overview

Xanthogranulomatous pyelonephritis (XGPN) is a rare disorder affecting the kidney which can fistulise to the colon in exceptional cases. We herein report a case of XGPN with renocolic fistula and large vessel thrombosis presenting with sepsis and pulmonary embolism. Preoperative diagnosis and strategic planning resulted in successful management. A 64-year-old woman presented to the emergency department with abdominal pain and a septic condition, corroborated by venous thromboembolism. Workup diagnosed a left renal abscess with calicocolic fistula. Scintigraphy confirmed a nonfunctioning left kidney. The patient underwent inferior vena cava filter placement and staged surgery. The first, damage control procedure was a loop ileostomy. Ten days later, when the patient’s conditions improved, she underwent left nephrectomy and left colectomy with primary anastomosis. Finally, a year later, the ileostomy was closed. At follow-up, the patient was well, with unremarkable renal function. Scrupulous diagnostics, multidisciplinary decision making, and staged intervention have been key to optimal outcome.

• Publisher: Hindawi,John Wiley & Sons, Inc,Wiley
• Subject: Abscesses / Anemia / Case Report / Case reports / Colon / Colorectal surgery / Disease / Etiology / Fistula / Kidney cancer / Lipids / Medical imaging / Ostomy / Pain / Patients / Pulmonary embolisms / Sepsis / Thrombosis / Urogenital system