PMC8631821_01
The general view and CT images of the nephrocutaneous fistula (NCF). (A,B) The fistula was 0.5 x 0.5 cm size and 6 cm deep on his left flank. (C) Abdominal CT showed the sinus tract (red arrow), extending from the surface of left kidney near the lower upper pole to the skin without renal/ureteral stone or hydronephrosis. (D,E) We injected contrast media into the sinus tract from the skin opening under pressure. The direction of the sinus tract is shown by the red arrow. (F-H) The three-dimensional reconstruction showed the relationship between the sinus tract and the left kidney. The sinus tract was marked green. We can see that the bottom of the sinus tract was closely connected with the lower pole of the left kidney.
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F1
Physical examination revealed that the fistula covered an area of 0.5 x 0.5 cm, and 6 cm deep on his left flank without tenderness or percussed pain (Figures 1A,B). Preoperative abdominal CT showed the sinus tract, extending from the surface of left kidney near the lower upper pole to the skin without renal/ureteral stone or hydronephrosis (Figures 1C-E). The three-dimensional reconstruction clearly showed the relationship between the sinus tract and the kidney (Figures 1F-H).
The fistulous tract endoscopic images and manifestation of surgery. (A) The fistulous tract endoscopy showed a mass of white flocculus stuck to the lining of the sinus tract. Because of the twist of the tract, our hard endoscopy cannot reach the bottom of the sinus tract. (B) Complete excision of the sinus tract under the guidance of methylene blue staining. The length of the tract was 6 to 7 cm. (C,F) A substantial amount of hard tissue similar to calcification and a hemoclip at the lower pole of the left kidney were founded. Removed all of these foreign objects. (D) Opened the posterior peritoneum and pulled part of the greater omentum tissue into the retroperitoneal space with oval forceps. (E) Tightly covered the left kidney with the omental flap.
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F2
Next, we performed a fistulous tract endoscopy, which showed a mass of white flocculus stuck to the lining of the sinus tract (Figure 2A). The bottom of the sinus tract was stuck to the lower pole of the left kidney (Figure 2B). We removed all the abnormal tissue and hemostasis (Figures 2C,F). Then, we tightly covered the left kidney with the omental flap and fixed it with sutures (Figures 2D,E).
Follow-up 6 months after the operation. (A) MR examination showed that the omental flap tightly covered the left kidney (red arrow) and cut the kidney off from the flank muscle. (B) The NCF and the surgical incision were completely healed.
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F3
Six months later, MR examination showed that the NCF had healed well with the omental flap tightly covering the kidney (Figures 3A,B).