[Spontaneous pneumopyelography for enteroureteral fistula].
OBJECTIVE
To report one outstanding case of fever and flank pain with the radiologic finding of air outlining the whole left upper urinary tract (pneumopyelography).


METHODS
The patient subject of this case had a history of gynaecologic surgery five years before presentation and subsequent diverticulitis one year later requiring discharge colostomy followed by reconstruction 7 months later. We performed a MEDLINE search using the terms "entero urinary fistula". Most papers are case reports with reviews of the diagnostic and therapeutic procedures, as well as the etiologic factors.


RESULTS
Radiologic tests are key to make this finding clear and to determine its location. In our patient, once the acute picture was controlled and the confirmatory diagnosis was made by means of barium enema, we proceeded with left simple nephrectomy and lower intestine resection including the fistula tract. Real incidence is unknown; there is a female predominance in the published cases. Depending on the casual mechanism, they may be classified as spontaneous or traumatic. Most of them are secondary to bowel inflammatory diseases like diverticulitis, Crohn's disease, tumors, ulcers,... They can also be secondary to impacted urinary lithiasis, urothelial tumor, endoscopic procedures, etc. Other cases are secondary to previous surgery and radiotherapy.


CONCLUSIONS
The finding of pneumopyelogram should prompt and interventional algorithm including radiologic tests and other examinations to allow a proper diagnosis and to perform an effective treatment.
Guzman Martínez-Valls
Pablo Luis
PL
Servicio de Urología, Hospital General Universitario Morales Meseguer, Mucia, España. pabloguzman@teleline.es
Hita Villaplana
Gregorio
G
Fernández Aparicio
Tomás
T
Miñana López
Bernardino
B
D005260:Female; D005740:Gases; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging*; D008875:Middle Aged; D014515:Ureteral Diseases / Q000000981:diagnostic imaging*; D014548:Urinary Fistula / Q000000981:diagnostic imaging*; D014567:Urography
D005740:Gases