PMC8310905_01
Timeline from deceased pediatric donor en-bloc kidney transplant (DDKT), renal allograft biopsy with subsequent development of uroenteric fistula which manifested as normal anion gap acidosis and watery diarrhea which was diagnosed by magnetic resonance imaging urogram (MRU), followed by surgical repair and discharge after 8 weeks of hospitalization. The daily fluid balance with urine and stool volumes are color coded.
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F1
The clinical course timeline is depicted in Figure 1.
3D magnetic resonance urogram (MRU) images show a urinoma to small bowel fistula. (A) Shows the 2 ureters of the pediatric-en-bloc kidney transplant draining into a 8.6 x 3.9 x 1.1 cm fluid collection (labeled "Urinoma") located in the right lateral abdominal wall. The connection between the distal ureters at the base of the collection is shown (short arrow). (B) Shows the urinoma has developed a fistulous tract (magenta highlight labeled "Fistula") which drains into the proximal small bowel limb where the excreted contrast is seen progressively filling the bowel. (C) This sequence shows a cross-section of the tiny fistula (red arrow). Note that the bright urine in the urinoma is seen starting to mix with the fluid in the adjacent bowel (curved arrows), in contrast to the otherwise dark bowel contents throughout the rest of the image. (D) This 3D maximum intensity projection shows the location of the urinoma along the right abdominal wall which is filling the markedly dilated bowel with fluid which is urine.
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F2
This extended upwards in between the lateral abdominal wall musculature (Figure 2).