PMC6202425_01
Abdominal/pelvic computed tomography (CT) image showing the renal mass before microwave ablation.
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F1
He was incidentally diagnosed with a 4.5-cm exophytic renal mass within the right kidney 8 months prior to presentation, which was treated with MWA 3 weeks prior to presentation (Figure 1).
Upper endoscopy of the duodenal fistula through the second portion of duodenum.
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F2
An emergent esophagogastroduodenoscopy (EGD) revealed no varices, but a large fistulous opening in the first portion of the duodenum was noted (Figure 2).
Internal view of fistula showing the occlusive clot.
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F3
When the endoscope was passed into the opening, adipose tissue and a large clot were noted (Figure 3).
CT image of the duodenorenal fistula.
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F4
An emergent computerized tomography (CT) scan of the abdomen and pelvis revealed a fluid collection in the right retroperitoneum, with air and oral contrast tracking from the duodenum to the ablated renal mass, suggestive of a fistulous tract (Figure 4).
Radiograph film taken (A) during angiography showing the bleeding artery and (B) after coiling of the bleeding artery.
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F5
Emergent angiography was performed by interventional radiology, revealing an active bleed from a branch of the right renal artery, which was coiled successfully (Figure 5).