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A Isaacson, K Woolley, N Sidhu, B Miller
Wayne State University

Rarely seen, and more rarely reported in the literature, ureteroduodenal fistulas are a significant potential complication after repair of traumatic injuries to these structures. If missed, these can lead to recurrent urinary tract infections (UTIs), urosepsis and septic shock. A High index of suspicion is needed when the proper injury pattern occurs. We describe a patient that developed this complication after a gunshot to the abdomen, who was initially asymptomatic.

A 41-year-old male presented as a level one trauma for a single gunshot wound to the abdomen after an altercation. He was in hemorrhagic shock and taken emergently to the operating room (OR). In the OR he underwent suture hepatorrhaphy, gastrorrhaphy, lateral duodenorrhaphy , right hemicolectomy and right ureteroureterostomy, with open packing. He returned to OR two days later for restoration of intestinal continuity and closure. He developed a urinary leak that was treated by percutaneous nephrostomy tube placement. He remained hospitalized for two weeks and was discharged home. He underwent a routine follow up nephrogram, upon which the fistula was discovered approximately two months post operatively.

The patient developed multiple UTIs, including a bout of urosepsis resulting in septic shock, intubation and a few days in the ICU. He recovered and was discharged. After a course of antibiotics, the patient underwent an exploratory laparotomy and fistula take-down two weeks later. He maintained his follow catheter for a week post-operatively. He underwent a percutaneous nephrogram through his nephrostomy tube six weeks post-operatively showing complete resolution of the fistula. The nephrostomy tube was discontinued

A rarely seen, but potentially serious complication after gunshot wounds involving the duodenum and the genitourinary system is fistula formation between the two. In our case, this occurred and the patient was initially asymptomatic. The fistula was incidentally noted on a follow-up percutaneous nephrogram for his urinary leak. The patient underwent a successful fistula take-down, was seen in follow up and is continuing to do well. Surgeons should keep this potential complication in mind when they have penetrating trauma involving both the ureter and duodenum

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