Calyceal-venous fistula of the kidney: a rare case
Calyceal-venous fistulas are rare complications that have been reported following percutaneous nephrolithotomy, ureteric obstruction or renal transplantation. Published in the journal Urology Case Reports, the authors present a case of a 52-year-old male, with a left upper pole calyceal-venous fistula.

Prior to hospitalization, this patient’s chief complaint was of longstanding constipation. Slow transit constipation was suspected. He underwent a flexible sigmoidoscopy with full thickness rectal biopsy, which revealed aganglionic bowel segments, suggestive of Hirschprung’s disease.

He underwent a laparotomy, extensive adhesiolysis, ultralow anterior resection and covering ileostomy. Intraoperative findings were that of extensive adhesions, and scarring around rectum to suggest previous pelvic dissection.

On post-operative day eight, he developed generalized abdominal pain with associated elevated inflammatory markers. Abdominal CT imaging showed marked left-sided periureteric and perinephric stranding with urothelial thickening. There was associated hydroureter and hydronephrosis.

On day 14, his condition did not improve despite antibiotic therapy and thus a repeat CT was obtained. A left renal vein thrombus was seen propagating into the inferior vena cava. In addition, a fistula is noted to be arising between the superior pole of the left kidney to the left renal vein with contrast opacification of the fistula tract.

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