Received: 14 December 2017 DOI: 10.1002/ccr3.1588
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Revised: 5 February 2018
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Accepted: 19 April 2018
CLINICAL IMAGE
Xanthogranulomatous pyelonephritis with psoas abscess and renocolic fistula Kazuya Kato1
| Yoshiaki Iwasaki2 | Yurina Kato1 | Kimitaka Kato1 |
Minoru Matsuda1
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Department of Surgery, Pippu Clinic, Pippu Town, Kamikawa-gun, Hokkaido, Japan 2
Department of Gastroenterology and Hepatology, Okayama University, Okayama City, Okayama, Japan Correspondence Kazuya Kato, Department of Surgery, Pippu Clinic, Pippu Town, Kamikawa-Gun, Hokkaido, Japan. Email:
[email protected]
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Key Clinical Message Xanthogranulomatous pyelonephritis (XGP) is an uncommon inflammatory disease of the kidney [1]. Diffuse XGP is a rare condition which may spread into the pelvic cavity leading to fatal complications from a psoas muscle abscess and/or renocolic fistula [2]. In diffuse type, nephrectomy and excision of the fistula is the recommended treatment. KEYWORDS psoas abscess, renal fistula, renocolic fistula, xanthogranulomatous pyelonephritis
| Q U E STIO N
What is happening to a thinning of the right renal cortex (Figure 1)?
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| A N SW E R
Xanthogranulomatous pyelonephritis (XGP) with a retroperitoneal abscess fistulating to the psoas muscle and the ascending colon. : An 89-year-old woman presented with a fever and right flank pain. Laboratory findings revealed leukocytosis of 28 800/mm3. Urine analysis revealed persistent pyuria. An abdominal noncontrast CT revealed a marked thinning of the right renal cortex and a large staghorn calculi filling the middle calyces in both kidneys and a right psoas abscess (Figure 1). Percutaneous drainage of the right psoas abscess was performed. The fistulogram revealed a nephron-psoas fistula with contrast leakage and a psoas abscess. An intravenous pyelography showed a nonvisualized right kidney with calculus and communication with the ascending colon (Figure 2). Considering the patient’s overall condition and
F I G U R E 1 A noncontrast abdominal computed tomography (CT). An abdominal noncontrast CT revealed a marked thinning of the right renal cortex and large staghorn calculi filling the middle calyces in both kidneys
age, she was not a candidate for surgery and was treated conservatively. The patient died 4 months after the initial admission due to DIC.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2018 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. Clin Case Rep. 2018;1–2.
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wileyonlinelibrary.com/journal/ccr3 1
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KATO et al.
and design. KKi: performed acquisition of data. KK, YI: performed analysis and interpretation of data, administrative, technical, or material support, and Study supervision. YK: performed drafting of the manuscript. KK, MM: performed critical revision of the manuscript for important intellectual content. ORCID Kazuya Kato
http://orcid.org/0000-0002-4512-9217
R E F E R E NC E S F I G U R E 2 An intravenous pyelography (IVP). The IVP showed
a right kidney with calculus and communication with the ascending colon
CONFLICT OF INTEREST None declared. AUTHOR CONTRIBUTIONS KK: had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. KK: performed study concept
1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;113:5s‐13s. 2. Harikrishnan JA, Hall TC, Hawkyard SJ. Nephrobronchial fistula. A case report and review of the literature. Cent European J Urol. 2011;64:50‐51.
How to cite this article: Kato K, Iwasaki Y, Kato Y, Kato K, Matsuda M. Xanthogranulomatous pyelonephritis with psoas abscess and renocolic fistula. Clin Case Rep. 2018;00:1–2. https://doi.org/10.1002/ccr3.1588
