Relevance of anatomical knowledge in unusual fistulas: simultaneous skin and liver skin secondary to rupture of pionefrosis. Case report

Abstract

Introduction: Pyonephrosis is a urinary tract infection, which is generally caused by partial or total occlusion of the ureter, where the accumulation of purulent material occurs in the pyelocalyceal system. In cases of untreated pyonephrosis, these can be complicated by spontaneous ruptures that in very rare cases lead to fistulas. More rare is the presentation of pyonephrosis as an abdominal wall abscess and even more rare is the relationship between these and liver abscess. Here we present a case that manifested as an abscess of the anterior abdominal wall and liver, with an unusual clinical presentation. Clinical case: A 38-year-old female patient with a history of pyonephrosis 6 months ago went to the emergency department due to discharge of secretion through the abdominal wall for 7 days with concomitant rise in temperature. Imaging studies were performed showing an abscess described at the time as intra-abdominal in the peritoneal cavity of 13 x 7.9 cm in diameter with a volume of 650 cc, liver abscess in segment VIII of 10 x 5.9 x 8 cm with a volume of average 250 cc, staghorn stone in right kidney. She was taken to the operating table where extraperitoneal abscess was evident, reported as intraperitoneal by imaging studies. Conclusion: Pielohepatic and pyelocutaneous fistula as a complication of pyonephrosis is a very rare clinical entity, very few cases have been reported in the literature. Now that we know about it, early diagnosis is key to the patient's survival.