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Pyeloenteric Fistula — Management

A pyeloenteric fistula is an abnormal communication between the renal pelvis and the bowel (most commonly duodenum, less commonly colon). Treatment depends on the underlying etiology, residual renal function, and patient fitness; nephron-sparing and minimally invasive options are increasingly preferred over reflexive nephrectomy. See clinical page: Pyeloenteric Fistula.

Conservative / Percutaneous Management​

Percutaneous nephrostomy to decompress the collecting system, with or without ureteral stenting, can allow spontaneous fistula closure — particularly for post-procedural or small fistulas. In a series of 40 upper-tract fistulas, percutaneous stenting was successful in 70% of cases.[1]

Endoscopic Approaches​

Endoscopic clipping and endoloop ligation have been reported as successful alternatives in patients unfit for surgery.[2] Percutaneous fulguration of the fistulous tract has also been described.[3]

Internal Ureteric Stenting​

Intraoperative or percutaneous internal stenting is an alternative to nephrectomy in selected cases.[4]

Definitive Surgery​

Nephrectomy with bowel repair (e.g., duodenal closure) is the traditional definitive approach when the kidney is non-functioning or chronically infected.[5]

Adjunct Principles​

Adequate nutrition, urinary tract diversion, treatment of the underlying inflammatory or infectious process, and gastrointestinal tract diversion when needed.[6]

References​

1. Maillet PJ, Pelle-Francoz D, Leriche A, Leclercq R, Demiaux C. Fistulas of the upper urinary tract: percutaneous management. J Urol. 1987;138(6):1382–5. doi:10.1016/s0022-5347(17)43648-2

2. Lee KN, Hwang IH, Shin MJ, et al. Pyeloduodenal fistula successfully treated by endoscopic ligation without surgical nephrectomy: case report. J Korean Med Sci. 2014;29(1):141–4. doi:10.3346/jkms.2014.29.1.141

3. Kim SC, Weiser AC, Nadler RB. Nephroenteric fistula treated with fulguration of the fistulous tract. J Endourol. 2000;14(5):443–5. doi:10.1089/end.2000.14.443

4. Desmond JM, Evans SE, Couch A, Morewood DJ. Pyeloduodenal fistulae. A report of two cases and review of the literature. Clin Radiol. 1989;40(3):267–70. doi:10.1016/s0009-9260(89)80194-1

5. Gentile PA, Gualtieri L, Izzo S, et al. Une liaison dangereuse: spontaneous pyeloduodenal fistula. Dig Dis Sci. 2023;68(4):1106–1111. doi:10.1007/s10620-023-07828-1

6. Gill HS. Diagnosis and surgical management of uroenteric fistula. Surg Clin North Am. 2016;96(3):583–92. doi:10.1016/j.suc.2016.02.012