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.
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

Twenty-four anatrophic nephrolithotomies under hypothermia were performed between June, 1980, and July, 1982, to remove staghorn and multiple renal calculi. 1. There were no operative deaths, and eight transient postoperative complications occurred. These complications resolved during their initial hospitalization, and no nephrectomies were required. 2. The average time of the operation was 4.17 hours, and the mean cold renal ischemic time was 51 minutes. The patient required an average of 1.9 pints of blood intraoperatively and no transfusion postoperatively. The average length of postoperative hospitalization was 10.3 days in all patients and 17.4 days in complicated cases. 3. Magnesium ammonium phosphate calculi were present in the major of patients (62.5%) in staghorn calculi and calcium oxalate (62.5%) in multiple renal calculi. 4. Postoperative evaluation was done in 16 of 24 patients. Seven patients (43.8%) has residual calculi. This high residual stone rate was due to lack of intraoperative roentgenography. 5. Among 16 patients, 9 had preoperative urinary tract infection. In 4 patients who had residual stone, 2 patients had perpetuated urinary tract infection and in 5 patients who had no residual stone, postoperative urine culture were sterile. 6. Intravenous pyelography was performed 3 months after the operation in 6 patients. Of these 6 patients 5 revealed stable or improved renal function. In 1 patient it revealed non-functioning kidney. We suppose it may be due to vascular spasm or injury.
Ammonium Compounds ; Calcium Oxalate ; Calculi ; Hospitalization ; Humans ; Hypothermia* ; Kidney ; Kidney Calculi ; Magnesium ; Nephrectomy ; Postoperative Complications ; Radiography ; Spasm ; Urinary Tract Infections ; Urography