Pyeloduodenal fistula diagnosed with technetium-99m scintigraphy and managed with a conservative strategy.
We present a case of pyeloduodenal fistula in an 89-year-old woman with history of nephrolithiasis and recurrent urinary tract infection (UTI) who presented to the emergency department with back pain. CT revealed a malrotated right kidney with a large renal stone and possible fistulous connection between the second portion of the duodenum and the right renal collecting system. Technetium-99m scintigraphy confirmed presence of the fistula. The patient declined intervention and was discharged from the hospital with oral antibiotic suppressive therapy. The patient remained clinically stable at time of follow-up 3 months later. Spontaneous pyeloduodenal fistula is an aetiology of recurrent upper or lower UTIs or persistent bacteriuria though uncommonly recognised. Diagnosis may be achieved using several modalities, including technetium-99m scintigraphy. Nephrectomy and primary fistula closure has traditionally been the treatment of choice for this condition; however, conservative management is an option for patients with intact renal function.
['Kobayashi|Takaaki|T|', 'Munoz Casablanca|Nitzy|N|', 'Harrington|Matthew|M|']
D000369:Aged, 80 and over D000892:Anti-Infective Agents, Urinary D000072700:Conservative Treatment D004378:Duodenal Diseases D004386:Duodenum D005260:Female D006801:Humans D007412:Intestinal Fistula D007668:Kidney D007669:Kidney Calculi D011877:Radionuclide Imaging D013667:Technetium D015662:Trimethoprim, Sulfamethoxazole Drug Combination D014552:Urinary Tract Infections
urinary tract infections urology