This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2023 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Reno-colic fistula, pneumaturia, chronic 
pyelonephretic kidney

None declared.

Patient Consent: Obtained.

Received on July 21, 2022 
Accepted on July 31, 2022

Soc Int Urol J. 2023;4(2):148–149

DOI: 10.48083/SCFA5828

A Rare Case of Reno-Colic Fistula Revealed  
by Pneumaturia

Achraf Chatar,1 Nizare Errabi,2 Ibrahim El Housni,2 Abdelghani Ammani2

1CHU Hassan II, Fes, Morocco 2 Military hospital Moulay Ismail, Meknes, Morocco

Reno-colic fistula is very rare, representing 5.1% of uro-digestive fistulas[1]. Causes can include infection, stone 
disease, malignancy, or trauma to the kidney or the colon. Pyelo-colic fistulas are in most cases of renal origin 
(lithiasis)[2]. Traumatic causes are other major groups reported mainly related to renal interventional techniques 
(cryoablation, radiofrequency, percutaneous nephrolithotomy). Infectious causes are rarer (tuberculosis, refractory 
infection of renal cysts)[3,4]. 

The general, digestive, or urinary clinical manifestations are often variable and non-specific, making the diagnosis 
difficult[5]. The research of fecaluria and/or pneumaturia helps to direct toward the diagnosis of uro-digestive fistula.

Abdominal-pelvic CT scan with contrast, upper and lower digestive radiography, or ureteropyelography retro-
grade and/or percutaneous descending pyelography often confirms the diagnosis by showing the passage of urinary 
contrast medium to the digestive tract or vice versa, thus providing information on the cause, nature, and location of 
the uro-digestive fistula.

FIGURE 1.

Cross section of the left kidney 
Pyelocalycial dilation

FIGURE 2.

One-piece resection: native left kidney (A) with  
fistula tract facing the left colon (B)

B

148 SIUJ  •  Volume 4, Number 2  •  March 2023 SIUJ.ORG

CLINICAL PICTURE

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The choice of conservative or radical treatment essen-
tially depends on the etiology and renal clearance. The 
radical treatment is nephrectomy with the closure of the 
privileged digestive fistula if the kidney is destroyed or 
a tumor etiology makes radical treatment unavoidable. 
Conservative treatment, if the fistula is post-traumatic 
with functional kidney, includes urinary drainage, anti-
biotic therapy, and rest of the digestive tract.

Our 65-year-old patient reported  repeated renal colic, 
with air emission during urination, and presented with 
a pyelo-colic fistula (Figures 1 and 2). Radical treatment 
was carried out. The anatomo-pathological analysis 
showed a chronic pyelonephretic kidney abscessed. with 
a destroyed kidney.  

References

1. Vidal Sans J, Reig Ruiz C. Fístulas urodigestivas: diagnóstico y 
tratamiento de 76 casos [Urodigestive fistulae: the diagnosis and 
treatment of 76 cases]. Arch Esp Urol.1995 Apr;48(3):241-6. Spanish. 
PMID: 7755430. 

2. Suhler A, Schimmel F, Viville C. Fistules entéro-urinaires d'origine 
rénale et pyélique [Intestinal urinary fistulas of renal and pelvis origin]. 
Ann Urol (Paris).1995;29(1):8-10. French. PMID: 7771759.

3. El Otmany A, Hamada H, Hachi H, Benjelloun S, Oukhira H, Souadka 
A. Fistule réno-sigmoïdienne sur un rein ectopique pelvien 
tuberculeux. Prog Urol.1999 Feb;9(1):122–124. 

4. Iwashita Y, Negi S, Iwashita Y, Higashiura M, Shigi Y, Yamanaka S, 
Ohya M, Mima T, Shigematsu T. Severe refractory infection due to 
renocolic fistula in a patient with a giant kidney and ADPKD undergoing 
long-term hemodialysis. CEN Case Rep.2018 May;7(1):174-177. doi: 
10.1007/s13730-018-0321-6. Epub 2018 Mar 14. PMID: 29536255; 
PMCID: PMC5886951.

5. Suhler A, Garbit JL, Blitz M. Fistules urétéro-intestinales [Uretero-
intestinal fistulas]. Ann Urol (Paris).1995;29(1):15-17. French. PMID: 
7771751.

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A Rare Case of Reno-Colic Fistula Revealed by Pneumaturia

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