J Korean Med Sci.  2014 Jan;29(1):141-144. 10.3346/jkms.2014.29.1.141.

Pyeloduodenal Fistula Successfully Treated By Endoscopic Ligation without Surgical Nephrectomy: Case Report

• Lee KN
• Hwang IH
• Shin MJ
• Lee SB
• Kim IY
• Lee DW
• Rhee H
• Yang BY
• Seong EY
• Kwak IS

• KMID: 1796928
• DOI: http://doi.org/10.3346/jkms.2014.29.1.141

Abstract

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.

Keyword

Duodenal Diseases; Intestinal Fistula; Kidney Diseases; Urinary Fistula; Endoscopy

MeSH Terms

Aged
Duodenal Diseases/complications/radiography/*surgery
Female
Humans
Hydronephrosis/complications/radiography
Intestinal Fistula/complications/radiography/*surgery
Kidney/radiography/surgery
Kidney Calculi/complications/radiography
Kidney Diseases/complications/radiography/*surgery
Ligation
Urethral Obstruction/complications/radiography
Urinary Fistula/complications/radiography/*surgery
Urinary Tract Infections/complications/radiography

Figure

• 

  Fig. 1 Antegrade pyelography shows the right pyeloduodenal fistula: (A, B) Leakage of contrast media to the duodenum from the right renal pelvis before endoscopic ligation on pyelography during nephrostomy. (C) No evidence of contrast leakage to the duodenum 1 week after successful endoscopic clipping and snaring.

• 

  Fig. 2 Gastroendoscopic findings: (A) Arrow indicates the fistula site in the duodenal 2nd portion, (B) endoscopic finding after clippings of the lesion. (C) Snaring of the fistula site.

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