Pyeloenteric Fistula

Abstract

Pyeloenteric fistulas communicate the renal pelvis with the gastrointestinal tract. They are a rare entity and represent a real challenge in diagnosis and therapeutic for specialists. The most frequent location is the left renocolic, followed by the right renocolic and renoduodenal. The most frequent aetiology is urological, mainly infectious and lithiasis, followed by iatrogenic given the increase in percutaneous and endourological procedures and post-traumatic. The clinical presentation is very varied and heterogeneous, so clinical suspicion is fundamental to reach a correct diagnosis. Computerized Tomography (CT) and antegrade or retrograde pyelography are the most used complementary tests. Initial management is mainly based on antibiotherapy, urinary diversion by the placement of a percutaneous nephrostomy and nutritional support. In most cases, definitive treatment is surgical by nephrectomy, excision of the fistulous tract and repair of the affected gastrointestinal segment. The exception is in iatrogenic aetiology, in which conservative management by urinary diversion is successful in most patients.