Introduction: The incidence of renal cell carcinoma has been increasing in recent years. The primary techniques for the treatment of these tumours are cryoablation, radiofrequency ablation, percutaneous ethanol injection, and microwave ablation. Computed tomography (CT)-guided percutaneous cryoablation is increasingly utilized for renal cell carcinoma. Bowel injury is a known complication but is extremely rare. This study presents a rare case of colorenal fistula after cryoablation of a left renal tumour.
Presentation of Case: A 58-year-old man with no significant
history was diagnosed with left renal carcinoma A left renal tumour was
incidentally found on an abdominal CT examination performed for a slight
increase in transaminases. Abdominal ultrasonography revealed a 31 × 32-mm
solid, well-defined, cortical tumour at the lower pole of his left kidney. The
patient was asymptomatic and had no distant metastasis. The decision was made
to treat the tumour with percutaneous cryoablation, with a good response to the
technique. Two months later, the patient had recurrent urinary tract infections
and pneumaturia. In the absence of improvement with antibiotic treatment, CT
was performed and revealed a fistula connecting the descending colon and renal
parenchyma. The decision was made to perform surgery to repair the defect
caused by percutaneous cryotherapy. The patient recovered from surgery and was
discharged with no complications.
Discussion: To reduce the adverse effects of radical or partial
nephrectomy and preserve renal function, percutaneous ablation techniques have
been developed. Internal injury is a known complication and it is particularly
common in cases of renal tumours located in the upper and anterior kidney. The
diagnosis is based on symptoms and imaging. Most colorenal fistulas have been
treated conservatively with good results.
Conclusion: Cryoablation of renal tumours is a safe, low-risk
procedure, but recurrent urinary tract infections and pneumaturia may indicate
a colorenal fistula, with conservative treatment preferred and surgery reserved
for persistent cases. If possible, conservative medical treatment should be
used,
reserving surgery for complicated or persistent colorenal
fistulas.
Author
(s) Details
Andoni Alaba
Sorabilla
Department of General Surgery, Sierrallana Hospital, Torrelavega,
Cantabria, Spain.
Julia Pelayo
Rodríguez
Department of General Surgery, Sierrallana Hospital, Torrelavega,
Cantabria, Spain.
Oihan Loidi
Lázaro-Carrasco
Department of General Surgery, Sierrallana Hospital, Torrelavega,
Cantabria, Spain.
Rubén Gonzalo
González
Department of General Surgery, Sierrallana Hospital, Torrelavega,
Cantabria, Spain.
Berta Martín Rivas
Department of General Surgery, Sierrallana Hospital,
Torrelavega, Cantabria, Spain.
José Manuel Gutiérrez
Cabezas
Department of General Surgery, Sierrallana Hospital, Torrelavega,
Cantabria, Spain.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v11/2520
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