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Emphysematous pyelocystitis in a renal allograft secondary to sigmoid diverticular disease and colovesical fistula: a case report
Pyelonephritis is a serious common complication of transplantation that can lead to either acute renal failure or graft loss. The occurrence of diverticulitis in a renal transplant recipient is a rare complication but ma...
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The study aimed at the prevalence of pyelonephritis and its association with some kidney diseases, function or structure, in Iraq, specifically in the province of Najaf, for a period of 16 months, from 2/1/2022 to 1/5/2023, where 1255 samples of males and females of different ages were collected, and the patients were divided into several groups de...
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... After 1 year, the ileostomy closure was done and the patient is stable on a regular follow-up. [1][2][3][4] Among the causes of colovesical fistula, the most common cause is diverticular disease (50%) followed by carcinoma of the colon (20%) and then Crohn's disease (10%). Less common causes include other surgeries, radiotherapy and other carcinomas. ...
Colovesical fistula per se is a rare condition and most commonly occurs secondary to diverticular disease in normal patients. Colovesical fistula in the setting of post-renal transplantation is even rarer and very few cases have been reported in literature. Patients with autosomal-dominant polycystic kidney disease (ADPKD) are predisposed to diverticulosis and hence are at a higher risk for fistula formation. Herein, we report a case of colovesical fistula in a renal allograft recipient with ADPKD in the absence of diverticulosis. The patient was successfully operated and is stable with no complications at 1-year follow-up.
Colovesical fistula is commonly suspected in cases of diverticular disease, malignancy, trauma, iatrogenic injury or radiotherapy. In a case of allogenic live related transplant, this is rarely expected, especially after 20 years. The presence of gas in the bladder in the absence of history of instrumentation of urinary tract should prompt us to evaluate for colovesical fistula. Pneumaturia, faecaluria and recurrent urinary tract infection are tell-tale features of colovesical fistula, and when patients who are renal allograft recipient present with them, it should prompt a proper workup and swift surgical management, since the outcome is uniformly favourable. From our knowledge in this realm, we know that these are immunocompromised patients and have a high tendency to develop risk factors like malignancy and/or diverticular disease and eventually form colovesical fistula. An expected time period could be from 2 months to 6 years. But in our case, fistula formation occurred long after peak corticosteroid action, in the absence of conventional aetiologies.
