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British Journal of Radiology (2007) 80, e1-e3
© 2007 British Institute of Radiology
doi: 10.1259/bjr/65194982
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An unusual case of pneumoperitoneum: nephrocolic fistula due to a giant renal staghorn calculus

C Alster, MD, PhD L F C Zantut, MD, PhD F Lorenzi, MD, PhD G S Marchini, MD B J M Onofrio, MD A A Nakashima, MD B E O Gatto, MD and D Birolini, MD, PhD

University of Sao Paolo, Sao Paolo, SP 05410-020, Brazil


Figure 1
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  		Figure 1. Radiology: (a) previous abdominal radiograph while the patient was seen at urology clinics which shows a right 10 cm renal stone; (b) abdominal radiograph at the ER with signs of pneumoperitoneum and pneumoretroperitoneum as well as the calculus impacted at the lower pelvis. Diagnosis: nephrocolic fistula and bowel perforation.

 

Figure 2
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  		Figure 2. CT: (a) abdominal CT taken 1 year prior to ER admission. Note the 10 cm calculus located at the renal pelvis on the right kidney, near the ascending colon where a fistula was forming (arrow) but was missed at that time. The renal parenchyma was atrophic. (b) Abdominal CT at the ER: the renal stone is impacted at the rectalsigmoid junction (arrow).

 

Figure 3
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  		Figure 3. Giant renal stone view: note the renal calculus now extracted at the rectosigmoid level, which was partially resected to take this picture. Then, a sigmoidectomy was performed together with a right nephrectomy and right hemicolectomy. The descending colon was then anastomosed to the rectum (manually) and an ileocolic anastomosis with a proximal protective ileostomy (closed 7 days later) was performed.

 




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