サンゴ状結石に合併した腎結腸瘻の1例

Abstract

A case of renocolic fistula complicating staghorn calculus was presented. A 62-year-old man who had been under the care of the department of medicine in our hospital with a diagnosis of diabetes mellitus was referred to our clinic because of left renal stone and psoas abscess. An intravenous urogram showed a normally functioning right kidney and a staghorn calculus in a non-functioning left kidney. By retrograde pyerogram, the contrast material entered the descending colon and retroperitoneal cavity from the renal pelvis. Barium enema also revealed the renocolic fistula. Laboratory findings showed mild anemia, hypoalbuminemia and renal dysfunction other than hyperglycemia. After the improvement of these complications, a left nephrectomy, excision of the fistulous tract and closure of the colon were performed. Postoperatively, progressive deterioration of renal function developed and he died on the 35th postoperative day. Twenty-three cases of reno-alimentary fistula including our case have been reported in Japan: renocolic fistula (II cases), renoduodenal fistula (9 cases), renoileal fistula (I case), renocecal fistula (I case) and reno-appendiceal fistula (I case). We considered the clinical course of our case in the aspect of renal function and reviewed the Japanese literatures on the relationship of the renal function to the prognosis of reno-alimentary fistula.