Spontaneous Nephrocutaneous fistula-A rare case report and review of literature

Spontaneous Nephrocutaneous Fistula (SNCF) is a very rare entity. The known causes are: post-operative, calculous pyonephrosis, chronic pyelonephritis, renal infections, perinephric abscess, trauma, xanthogranulomatous pyelonephritis, renal tumours, open surgical procedures, reflux diseases and renal tuberculosis. Till 2013 only 29 cases were published. It is usually associated with obstructing calculus and non functioning kidney. A case of nephrocutaneous fistula in a 67 years old female patient complaining of seropurulent discharge from a fistula over the right lumbar flank for the last eight month, is presented and discussed here, for its rarity and management. CT fistulogram was performed which revealed a fistulous tract from the skin to the pelvicalyceal system of the right kidney, calcification of the renal parenchyma and obstructing renal stones (obstructive uropathy). Patient was investigated for renal tuberculosis, was found positive and was put on anti tubercular treatment to which she responded ,as the fistula healed and closed spontaneously. Open nephrectomy along with excision of the tract was performed. Follow up period remained uneventful. Open surgery, after 3-4 weeks of antitubercular treatment (ATT), is recommended in such cases.