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Upper Gastrointestinal Bleeding Revealing Renogastric Fistula: A Case Report and Literature Review.

1. Introduction

A renogastric fistula is an extremely rare complication, always affecting the left kidney, and it is among the rarest fistulas between the urinary and digestive tracts [1].

2. Case Report

A 53-year-old patient followed for chronic renal failure (whose etiology is bilateral renal polycystosis in the hemodialysis stage) and also followed for bladder tumor (urothelium grade 2) was admitted to the intensive care unit for the management of hemorrhagic shock following upper digestive bleeding.

The clinical examination found the patient with GSC 13/15, with arterial hypotension at 85/46 mmHg, tachycardic at 115, with diuresis at 0.3ml/kg/h, and with macroscopic hematuria. The respiratory examination found the patient polypneic at 26 and with ambient air saturation at 85%. The abdominal examination found an epigastric sensitivity with touch and rectal absence of melena.

The biological assessment had objectified hemoglobin level at 5.9g/dl, platelets at 195,000/[mm.sup.3], TP at 60%, renal failure with creatinemia at 85mg/l and urea level at 1.1 g/l, hyponatremia at 132mEq/l, and hyperkalemia at 5.9mEq/l.

Our management was to transfuse the patient with 2 units of red blood cells, administer norepinephrine on a central venous catheter, and make hypokalemic measurements.

After stabilization, the patient had an abdominal CT scan that objectified a large hematoma of the left kidney fistulated in the stomach (Figure 1).

Unfortunately, the patient died after the second episode of haematemesis of great abundance and complicated refractory hemorrhagic shock, before a hemostasis procedure was performed.

3. Discussion

A fistula is an abnormal communication between 2 epithelium-lined cavities. Urointestinal fistulas can occur between any part of the urinary system and the digestive tract. They are rare and renogastric fistulas are the least common fistula between the urinary and digestive tracts. They are most often of chronic inflammatory origin, secondary to kidney stones or traumatic origin [2, 3]. Normally, if a fistula should develop between the kidney and the gastrointestinal tract, it will do so at sites directly related the kidney: either between the right kidney and the duodenum or the kidney and the colon [4]. The most frequent clinical signs found in cases of urointestinal fistulas are nausea-vomiting, lumbar pain, hematuria, pyuria, and fever [5]. Diagnosis is based on CT scan, which determines the nature, location, and sometimes the etiology and complications of these fistulas [6]. The treatment consists in majority of cases in nephrectomy and digestive suture [7].

4. Conclusion

A renogastric fistula is a rare complication with a variety of etiologies and clinical signs, and diagnosis is based on CT scan and treatment is often surgical.

https://doi.org/10.1155/2020/3018347

Conflicts of Interest

The authors do not declare any conflict of interest. Authors' Contributions

All authors have read and approved the final version of the manuscript.

References

[1] L. A. Farina, J. Caparros, J. Palou, and A. Rousaud, "Renogastric fistula," Journal of Urology, vol. 147, 3 Part 1, pp. 677-678, 1992.

[2] M. Curtis, C. Ney, M. Dave, F. Cruz, and G. Pandya, "Renogastric fistula secondary to a staghorn calculus," The Journal of Urology, vol. 156, pp. 1434-1435, 1996.

[3] H. S. Gill, "Diagnosis and surgical management of uroenteric fistula," The Surgical Clinics of North America, vol. 96, no. 3, pp. 583-592, 2016.

[4] M. Dunn and D. Kirk, "Renogastric fistula: case report and review of the literature," The Journal of Urology, vol. 109, no. 5, pp. 785-787, 1973.

[5] J. R. Brian, G. G. James, J. T. Timothy, and H. L. John, "Ureteroduodenal fistula," Urology, vol. 48, no. 2, pp. 301-302, 1996.

[6] D. Campobasso, P. Granelli, U. Maestroni, D. Cerasi, S. Ferretti, and P. Cortellini, "Are nephroenteric fistulas only a surgical trouble?," The Indian Journal of Surgery, vol. 77, no. 3, pp. 222-225, 2015.

[7] D. Touiti, A. Ameur, I. Zrara, A. Beddouch, H. Oukheira, and S. Benomar, "Renocolic fistula: a case study," Annales d'Urologie, vol. 35, no. 1, pp. 44-46, 2001.

Yassine Mellagui [ID], Inass Haouli, Jamal Ouachaou [ID], Mohammed Aabdi, Houssam Bkiyar, and Brahim Housni

Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medicine and Pharmacy ofOujda, Mohammed VI University, Oujda, Morocco

Correspondence should be addressed to Yassine Mellagui; mellaguiyassine@gmail.com

Received 16 February 2020; Accepted 9 March 2020; Published 20 March 2020

Academic Editor: Francesco M. Solivetti

Caption: Figure 1: Abdominal scanner without contrast injection showing a large hematoma of the left kidney fistulated in the stomach.
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Title Annotation:Case Report
Author:Mellagui, Yassine; Haouli, Inass; Ouachaou, Jamal; Aabdi, Mohammed; Bkiyar, Houssam; Housni, Brahim
Publication:Case Reports in Urology
Article Type:Report
Date:Mar 31, 2020
Words:740
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