Colorenal fistula and urinary tract infection in a pediatric patient with acute lymphoblastic leukemia. / Fístula colorrenal e infección de vías urinarias en paciente pediátrico con leucemia linfoide aguda.

INTRODUCTION: Colorenal fistula is rare in the pediatric population. It may occur at any segment involved by ischemia, chronic inflammation, or necrosis. It is typically associated with a preliminary renal lesion that may arise as a result of interventional procedures, inflammatory conditions, colon tumor, and xanthogranulomatous pyelonephritis, among others. CASE REPORT: 15-year-old female patient diagnosed with acute lymphoblastic leukemia admitted at our institution for baseline condition management. During her stay, she experienced gastrointestinal and urinary infectious events. In the assessment and management of those, a left colorenal fistula was found. Surgical treatment was decided upon. DISCUSSION: Colorenal fistula typically occurs secondary to renal inflammation or infection. Clinical signs are highly variable, and treatment is surgical, with the fistulous tract being resected in all cases.

INTRODUCCION: Las fístulas colorrenales son infrecuentes en la población pediátrica. Pueden desarrollarse en cualquier segmento afectado por isquemia, inflamación crónica o necrosis. Suelen estar asociadas a una lesión primitiva en el riñón que puede producirse por procedimientos intervencionistas, enfermedades inflamatorias, tumorales del colon, pielonefritis xantogranulomatosa, entre otras. CASO CLINICO: Paciente femenina de 15 años, con diagnóstico de leucemia linfoide aguda, ingresa a la institución para recibir manejo de su enfermedad de base. Durante su evolución, desarrolla eventos infecciosos (gastrointestinales y urinarios), y en evaluación y manejo de estos se documenta fístula colorrenal izquierda, motivo por el cual se da un enfoque de tratamiento quirúrgico. COMENTARIOS: La fístula renocólica generalmente se presenta secundaria a procesos inflamatorios o infecciosos renales; su presentación clínica es muy variada, y el tratamiento es quirúrgico, incluyendo siempre la resección del trayecto fistuloso.

Colorenal fistula after renal tumour cryotherapy.

INTRODUCTION: Computed tomography (CT)-guided percutaneous cryoablation is increasingly utilized for renal cell carcinoma. Bowel injury is a known complication but is extremely rare. We herein present the case of a 58-year-old man diagnosed with a colorenal fistula after cryoablation of a left renal tumour. PRESENTATION OF CASE: A left renal tumour was incidentally found on abdominal CT examination performed for a slight increase in transaminases. Abdominal ultrasonography revealed a 31 × 32-mm solid, well-defined, cortical tumour at the lower pole of his left kidney. The patient was asymptomatic and had no distant metastasis. The decision was made to treat the tumour with percutaneous cryoablation, with good response to the technique. Two months later, the patient had recurrent urinary tract infections and pneumaturia. In the absence of improvement with antibiotic treatment, CT was performed and revealed a fistula connecting the descending colon and renal parenchyma. The decision was made to perform surgery to repair the defect caused by percutaneous cryotherapy. DISCUSSION: To reduce adverse effects of the procedure and preserve renal function, percutaneous ablation techniques have been developed. Internal injury is a known complication and it is particularly common in cases of renal tumours located in the upper and anterior kidney. The diagnosis is based on symptoms and imaging. Most colorenal fistulas have been treated conservatively with good results. CONCLUSION: The patient recovered from surgery and was discharged with no complications.

Digestive Tract Complications of Renal Cryoablation.

We report a case each of duodenorenal and colorenal fistula that arose after computed tomography-guided percutaneous cryoablation (PCA) for renal cell carcinoma and use imaging and endoscopic findings to analyze their causes and mechanisms. Both complications occurred though the edge of the iceball did not touch the intestinal wall, and patients' symptoms and fistula formation occurred several days after the PCA procedure. Based on imaging and endoscopy findings, we suspected the colorenal fistula resulted from bowel injury caused by ischemia from the occlusion of small vessels at the procedure's low temperature. Both cases were resolved conservatively without surgical intervention.