Renojejunal fistula: an extremely rare form of renoenteric fistula.

Dear Editor, Obstructive calculous disease of the kidney often results in infectious complications such as pyelonephritis and perinephric abscesses. Renojejunal fi stula formation may occur as the infl ammation becomes chronic. We report one such case and review 4 other cases reported in the literature. A 55-year-old Malay gentleman presented with left-sided pyonephrosis with a concomitant psoas abscess. He was known to have recurrent upper tract infections secondary to an upper ureteric stone for which he had undergone multiple nephrostomies. There was no associated pneumaturia nor abnormal faeculant contents in his urine. In this episode, both the renal pelvis and psoas abscess were drained percutaneously and radionuclide scan confi rmed a poorly functioning kidney. Subsequent antegrade studies showed communication between the renal pelvis, psoas abscess as well as the jejunum. The patient was given a trial of conservative management. In addition to draining the abscess, the infection was controlled with intravenous antibiotics and the bowel rested with nil-by-mouth and total parenteral nutrition. However, interval scans showed persistent fi stulous communication although there was a reduction in the size of the abscess. Surgical intervention was thus instituted and at laparotomy, the fi stula was noted to track from the hydronephrotic kidney, through the mesentery of the descending colon and into the jejunum as it emerged from the duodeno-jejunal junction. The kidney was thin-walled and embedded in a thick mass of fi brotic, infl ammatory tissue. A window was created in the mesocolon, sparing the marginal artery, in order to excise the fi stula track. Left nephrectomy was performed. A wedge segment of the involved jejunum was excised with primary closure of the small bowel wall. The mesocolon window was closed to avoid internal herniation. The patient made a rapid recovery with no immediate postoperative complication. Renoenteric fi stulae itself is a rare entity and is known to occur in chronic infl ammatory diseases of the kidney such as xanthogranulomatous pyelonephritis. Other diseases of the kidney causing renoenteric fi stulae include tuberculous infections, malignancy with obstruction and rarely, fungal infections. Iatrogenic surgical trauma, especially those related to percutaneous access of the kidney, may also result in fi stulation into the bowel. The most common type of renoenteric fi stula is renocolic fi stula because of the immediate relations of the ascending and descending colons to the kidney. Renoduodenal fi stulae Renojejunal Fistula: An Extremely Rare Form of Renoenteric Fistula