1242 A Surfacing Staghorn: Spontaneous Expulsion of a Large Renal Calculus from A Nephrocutaneous Fistula

An 83-year-old lady presented to the urology department with right flank pain in the context of a previously known right renal staghorn calculus. On examination, she was found to have a visible discharging sinus in her right flank, and the renal calculus had become visible at the skin surface. Non-contrast CT imaging confirmed that her staghorn calculus had eroded through the skin via a nephrocutaneous fistula. The stone was manually extracted percutaneously on the ward, and she was treated with intravenous antibiotics. She subsequently passed a further stone through the tract and made a good recovery. This is a highly unusual presentation of nephrolithiasis in a developed country in the 21st century. Review of the literature suggests that surgical management is almost always indicated in patients with staghorn calculi. However surgical management options are not without risk and conservative management of staghorn disease may be appropriate in select patient groups: those with multiple co-morbidities at high risk for GA, in cases of patient refusal of surgery, or in patients with aberrant anatomical factors Our case highlights a potential complication of conservatively managed staghorn stone disease. To our knowledge our case is the first of spontaneous expulsion of renal stone of this size to be reported in the developed world.

A rare case of spontaneous nephrocutaneous fistula

Acute and chronic pyelonephritis are known afflictions to the kidney in diabetics and in patients of abnormal urinary anatomy. And its presentation as a spontaneous sinus opening on the anterior abdominal wall is a rare phenomenon. We present one such rare case of a 71-year-old male with pus discharge from the anterior abdominal wall for 7 months. On investigating, it was found to be a nephrocutaneous fistula arising from the left non-functional kidney. This was dealt with left nephrectomy along with excision of the sinus tract. Though a very rare condition, a possibility of nephrocutaneous fistula must be kept when dealing with discharging sinus in lumbar region.

Nephrocutaneous fistula due to textiloma with in the pelvicalyceal system

Textiloma or gossypiboma is an embarrassing surgical scenario. Nephrocutaneous fistula is itself a rare complication after renal surgeries, but due to textiloma, it is rarest of the rare. In this case, 30-year-old lady presented with the complaints of chronic seropurulent discharge from a wound on her right lumbar region. On exploration it was found to be a retained surgical sponge in pelvicalyceal system, which was there for last seven years.