1. Calyceal Cutaneous Fistula Connor Deal February 2013

2. HPI: 73 year old female with recurrent right flank abscess s/p drainage (3/2012, 9/2012) who presents with further work- up of recurrent abscess – suspicion for enterocutaneous fistula. No fevers/chills. PMH: HTN, CKD, Nephrolithiasis, DVT (2/2012), DM PSH: Kidney stone removal (1969), Right flank abscess drainage (3/2012, 9/2012), av fistula placement (7/2012), ivc filter (2/2012) PE: Vitals: WNL; Gen:AOx3; Back:Guaze/Tegaderm over R- flank abscess with milky/yellowish purulent drainage. Slightly tender. Labs: BUN: 55; Bicarb: 15; Creat: 4.16; WBC 14.86 History

3. We know there is an abscess. Is there a fistula? DDx

4. ACR Criteria for suspected abscess

5. TIMELINE March 2012 drain R flank abscess 2/4/2013 Admission 2/5/2013 12:20pm Fluoroscopy 2/5/2013 2:30pm Ultrasound 2/5/2013 9:14pm CT Abdomen 2/6/2013 IR Drainage Sept 2012 drain R flank abscess

6. Fluoro Sinogram Fistulogram GI tract only -Prior to full injection of contrast What is this? 5193023

7. Fluoro Sinogram Fistulogram GI tract only 5193023

8. 5193549 CT Abdomen W/O IV contrast – Coronal View

9. 5193549 CT Abdomen W/O IV contrast – Saggital View Air bubble?

10. IR drain placed by IR – 1 month duration flagyl and levaquin – for diverticulitis Followup Future of kidney? Outcome

11. 65 yo female with right flank pain found to have complete right staghorn calculus with nephrocutaneous fistula. Fistula found by retrograde pyelogram which also confirmed the need for complete right nephrectomy. Case Report (1990)

12. Figure 3: Right retrograde pyelogram shows the pelvic calcification outside the ureter and a fistulous tract between the renal pelvis and the skin.

13. Charles JC. Nephrocutaneous fistula. J Natl Med Assoc. 1990;82 (8): 589-90. PMID PMC2626966 Reference