From Urinary Diversion to Gastrointestinal Complication: A Case of Nephrocolonic Fistula Post-Percutaneous Nephrostomy

Nephrocolonic fistulas are a rare entity that present with clincoradiological, diagnostic, and therapeutic difficulties.^1,2 A 57-year-old female underwent a percutaneous nephrolithostomy (PCN) for staghorn renal calculi. Five and a half years later she developed diarrhea. Investigation showed a DJ stent in situ, which was not draining. The patient had decreased urine output and hydronephrosis. The DJ stent was removed. Fresh stenting failed; subsequently, PCN was conducted to relieve obstruction. There was turbid output from the PCN (about 600 mL to 1 L/ day). A PCNgram under fluoroscopic guidance showed a contrast leak into the large bowel. A confirmatory non-contrast computed tomography with contrast injected through the PCN delineated a fistulous communication between the ascending colon and middle pole calyx [Figure 1a and b]. Further, there was contrast opacification in the colon. Both kidneys were atrophic. The left kidney showed calculi with mild hydroureteronephrosis [Figure 1c]. Another PCN was placed to decompress the fistulous tract [Figure 1d].

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Figure 1:

Computed tomography of the abdomen (a-d) shows the fistulous tract between the right kidney and the ascending colon, in the (a) axials and the (b) coronal sections left kidney is atrophic with (c) dilated renal pelvis and ureters (not shown), the (d) tip of the fresh percutaneous nephrostomy tube is seen in situ (Bone window).

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Nephrocolonic fistulas can be iatrogenic or spontaneous, and the latter is caused by malignancy of the bowel or the kidney, inflammatory conditions like xanthogranulomatous pyelonephritis, diverticulitis, and Crohn’s disease.³ The likely etiology could be iatrogenic after PCN placement. The diagnostic modalities include NCCT KUB scan with contrast through the rectum or the PCN if it is in situ. The patient’s presentation was atypical, with bowel complaints rather than urinary complaints.