Nephrobronchial fistula complicating neglected nephrolithiasis and xanthogranulomatous pyelonephritis.

Nephrobronchial fistula is a rare complication seen in association with renal infections, trauma or stone disease. Xanthogranulomatous pyelonephritis (XGP) is an infectious disease with a potential for fistulization to lung, skin, colon and other organs. We present a case of nephrolithiasis complicated by obstruction leading to pyonephrosis and nephrobronchial fistula, treated successfully by nephrectomy and excision of fistulous tracts. Nephrobronchial fistula, although a rare complication of longstanding renal stone, should be considered when a patient presents with perirenal suppurative process. This clinical case illustrates the natural history of nephro-bronchial fistula and the relevance of early treatment of nephrolithiasis.

Surgical drainage of primary iliopsoas abscess--safe and cost-effective treatment.

The report evaluates surgical drainage (SD) as a primary treatment of primary iliopsoas abscess (PIA). Seventy-two patients, who underwent SD for PIA at B P Koirala Institute of Health Sciences, Dharan, Nepal were studied. SD was performed through a lower abdominal, extra peritoneel, muscle splitting incision. Ultrasonography was used to diagnose the abscess in 53/54 patients (98%). Staphylococcus aureus was the most frequent organism grown in 45/65 patients (69%). The mean duration of drainage was 3.2 +/- 1.4 days (range, 1-7 days). The treatment was successful in resolving the abscesses in all patients. The mean hospital stay was 9.0 +/- 5.4 days (range, 3-40 days). Two patients (2.8%) developed a recurrence, 10 months and 1 year after the operation, respectively. Another patient developed an incisional hernia. There were no deaths. The average cost of treatment to the patient was approximately Nepali rupees 2800 (US$ 40). Surgical drainage appears to be a cost-effective and safe treatment for PIA.