多團隊內視鏡治療十二指腸腎皮瘘

  李宗霖、潘柏諺、林國仁、王敘涵、王大民、林志德

林口長庚紀念醫院泌尿科

Multi-team endoscopic management of duodeno-reno-cutaneous fistula

  Chung-Lin Lee, Po-Yen Pan, Kuo-Jen Lin,Hsu-Han Wang,Ta-Min Wang,Chih-Te Lin

 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan

Pyeloduodenal fistulae are rare and usually occur between the right renal pelvis and the duodenum due to their anatomical proximity. Pyeloduodenal fistula occurring due to local extension of emphysematous pyelonephritis has been described as a rare entity. We present the case of a 60-year-old female patient diagnosed with a gastrointestinal stromal tumor (GIST) causing bilateral ureteral compression leading to acute kidney injury (AKI). Percutaneous nephrostomy (PCN) was initially placed by the urology team, but bile discharge from the PCN site on the third postoperative day prompted further investigation. Computed tomography (CT) revealed inadvertent PCN insertion into the duodenum, necessitating corrective measures including PCN repositioning under C-arm guidance, bilateral double-J (DJ) stent placement, and endoscopic clipping of the duodenal opening to prevent bile leakage. Contrast imaging confirmed absence of leakage post-intervention. This case underscores the rare occurrence and management challenges of pyeloduodenal fistula secondary to GIST-related ureteral obstruction and an unique measurement of multiple disciplines involved which are never mentioned by lectures.