[Diffuse xanthogranulomatous pyelonephritis with a renocolic fistula neglected for more than two years].

INTRODUCTION

Although reno-colic fistula is a well-known complication of the diffuse form of xanthogranulomatous pyelonephritis, the features of the case here presented are unusual because of the paucity of symptoms and long lasting evolution of the disease before it was diagnosed.

CLINICAL CASE: A 75 year-old woman was seen at the emergency room complaining of fever and malaise. Physical and laboratory examination showed anemia and a left abdominal mass, and on X-ray and abdominal CT, a gross stone and huge left renal and extrarenal xanthogranulomatous pyelonephritis with renocolic fistula were disclosed. A review of her clinical record showed an X-ray performed two years before by the attending family clinician, with identical gross calculi and gas into the kidney. Nephrectomy, caudal pancreatectomy and partial colectomy were accomplished with good results.

COMMENT: This case of poor-symptomatic xanthogranulomatous pyelonephritis that destroyed the kidney and induced a renocolic fistula, is unusual because it was neglected for more than two years due to unawareness of the clinical and radiological picture.