A case with fistula formation between a perinephric retroperitoneal abscess and the duodenum: successful outcome after conservative management.
A 67-year-old woman diagnosed with pyonephrosis and perinephric abscess because of an impacted urinary stone in the pelvicoureteric junction was admitted to the hospital with a high-grade fever. Although construction of a right nephrostomy for drainage of the abscess improved her general condition, she had a fever again 2 weeks after the initial treatment. Computed tomography revealed a persistent perinephric retroperitoneal abscess and a second drainage procedure was performed. Then, imaging examination revealed fistula formation between the cavity of the perinephric retroperitoneal abscess and the duodenum. The patient received conservative management including percutaneous drainage, discontinuation of oral intake, and antimicrobial chemotherapy. Three days after the second drainage and discontinuation of oral intake, imaging examination revealed complete closure of the fistula. Fistula formation between a perinephric abscess and the duodenum is very rare but a favorable outcome was obtained by our conservative management.
Department of Urology, Sapporo Medical University School of Medicine, S. 1, W. 16, Chuo-ku, Sapporo, 060-8543, Japan.
Masahiro
M
Matsuki
Satoshi
S
Takahashi
Shin-Ichi
S
Hisasue
Takashi
T
Muranaka
Akio
A
Takayanagi
Takeshi
T
Maehana
Teruhisa
T
Uehara
Naoya
N
Masumori
Taiji
T
Tsukamoto
D018784:Abdominal Abscess / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D000368:Aged; D016154:Digestive System Fistula / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D004378:Duodenal Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013293:Enterococcus faecalis / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications; D009403:Nephrostomy, Percutaneous; D010501:Perinephritis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D053018:Pyonephrosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D011859:Radiography; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging; D016896:Treatment Outcome