Kidney Week

Abstract: SA-PO0051

Renocolic Fistula Secondary to Emphysematous Pyelonephritis: A Case Report and Surgical Management

Session Information

• AKI: Novel Patient Populations and Case Reports
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Valdivieso, Jorge Andres, Marshall University, Huntington, West Virginia, United States

Jorge Andres Valdivieso, MD

• Dirani, Michella, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador

Michella Dirani

• Monge, Andrés Ricardo, Universidad de Las Americas Facultad de Ciencias de la Salud, Quito, Pichincha, Ecuador

Andrés Ricardo Monge, MD

• Salamanca Espitia, Juan Sebastián, Universidad de Las Americas Facultad de Ciencias de la Salud, Quito, Pichincha, Ecuador

Juan Sebastián Salamanca Espitia, MD

• Ramon, Gabriela, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador

Gabriela Ramon

• Cedeño, Gabriel, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador

Gabriel Cedeño, MD

Introduction

Renocolic fistulas are rare abnormal communications between the kidney and the colon, often resulting from chronic infection, malignancy, or inflammatory disease. Their rarity is attributed to the kidney’s retroperitoneal location, protected by peritoneum, fascia, and fat.

Case Description

A 73-year-old woman with a history of diabetes, recurrent urinary tract infections (UTIs), and emphysematous pyelonephritis presented with hematuria and decreased oral intake despite prior antibiotic therapy. Due to recurrent infections and clinical instability, surgical management was planned. Preoperative abdominal CT revealed a renocolic fistula, left renal abscess, and hydronephrosis. The patient underwent left nephrectomy, abscess drainage, fistulectomy, and bowel resection. Postoperatively, she experienced hypotension and oliguria, requiring ICU admission, but recovered well and was discharged with follow-up care instructions.

Discussion

This case highlights a rare but serious complication of emphysematous pyelonephritis. Clinicians should consider this diagnosis in patients with recurrent UTIs and atypical imaging findings. CT imaging remains the diagnostic modality of choice, and the underlying etiology, fistula size, and patient stability should guide management. In such patients, particularly those with known emphysematous pyelonephritis, a renocolic fistula should be on the differential. Early recognition and timely surgical intervention can prevent complications and improve outcomes.

A: A coronal view of the abdomen suggestive of a renocolonic fistula.
B: Cross-sectional view of the abdomen consistent with a inflammatory connection.
C: a sagittal view highlighting the fistulous tract
D: A surgical view of the renocolonic fistula

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20256w27zg85