Nephrocutaneous Fistula Associated With Long-Term Ureteral Stenting and Renal Stones Requiring Nephrectomy With Partial Inferior Vena Cava Resection: A Case Report.

Nephrocutaneous fistula (NCF) is a rare condition typically associated with chronic infections, such as renal calculi or xanthogranulomatous pyelonephritis. Here, we report a case of NCF in which open nephrectomy required partial resection of the inferior vena cava (IVC) due to severe hilar adhesions. A 64-year-old woman in a prolonged bedridden state following intracerebral hemorrhage presented with fever, pain in the right flank, and purulent discharge from the right lumbar region. She had a long-term indwelling ureteral stent for the right ureteral stones. Contrast-enhanced computed tomography (CT) revealed a renal stone protruding beyond the renal parenchyma with a fistulous tract extending to the skin, consistent with NCF. Marked perihilar fat stranding and hilar lymphadenopathy were also observed. After infection control with meropenem hydrate, an open right nephrectomy was performed. Severe adhesions were observed around the renal hilum. Intraoperative injury to the right renal vein occurred during dissection, necessitating partial IVC resection for vascular control. NCF should be considered in patients with a long-standing infection, renal stones, or prolonged ureteral stenting who present with cutaneous abscesses or persistent flank discharge. Preoperative CT findings, such as marked perihilar fat stranding and hilar lymphadenopathy, may predict severe adhesions around renal vessels. Surgeons should keep these possible complications in mind and be prepared for complex vascular procedures, including possible IVC resection.