Staghorn Renal Calculus with Xanthogranulomatous Pyelonephritis and Renocolic Fistula

Risheng Xu, DO Former Triton Hospitalists at the Houston Methodist Willowbrook Hospital, University of Texas HSC at Houston Lyndon B. Johnson Hospital Academic Hospitalist Khawaja Azimuddin, MD FACS FASCRS Northwest ColonRectal Surgery Physician Association, Houston, TX Reno-colic fistula is rare, and even fewer cases were reported in association with staghorn stones and xanthogranulomatous pyelonephritis (XGP). Here we present a case of reno-colic fistula initially presented as recurrent urinary tract infections (UTI) at outside facility and empirically treated with antibiotics without improvement. Patient was admitted to us and found to have staghorn renal calculus with renocolic fistula and pathology features of XGP. Renocolic fistulas complicating staghorn calculus and in association with features of XGP are rare. Although they may present as recurrent UTIs initially, further work up to rule out a fistula should be entertained as imagine modalities are limited in initial diagnosis of fistulas. A high clinical suspicion to rule out fistula should be kept when initial imaging shows staghorn calculus with XGP features. Repeat imaging with contrast is helpful in evaluating renocolic fistulas. Treatment involves nephrectomy with partial colectomy. Post operative prognosis is generally good.