Pyeloduodenal fistula in a patient with xanthogranulomatous pyelonephritis: First case report in Latin America

Introduction Xanthogranulomatous pyelonephritis is an atypical chronic infectious disease of the kidney. Essentially it is characterised by the destruction of the renal parenchyma, associated with multiple fluid-filled cavities that replace it. It is a rare entity, and represents 0.6% of the types of pyelonephritis, and 19.2% of nephrectomies performed in patients diagnosed with pyelonephritis. Among complications of xanthogranulomatous pyelonephritis described in the literature are fistulas, and within these only two cases of pyeloduodenal fistula are described. This article is the first case report described in Latin America. Methods Case report and literature review. Case A forty-year old woman with symptoms in the previous 6 months of right flank pain radiating to the thoracolumbar region, associated with nausea, fever and tachycardia. Laboratory tests show an elevated white blood count, increased percentage of neutrophils, and normochromic normocytic anaemia. Contrasted images revealed changes suggesting xanthogranulomatous pyelonephritis with a pyeloduodenal fistula. Later, the patient underwent a right radical nephrectomy and the primary closure of small intestine with omentum patch. Conclusion Spontaneous pyeloduodenal fistulas require a surgical management including nephrectomy, in order to control the infectious focus, and an omentum patch to close the fistula. This procedure must be performed by a multidisciplinary team.