Amanullah Abbasi, Mohsin Wamiq Qadri, Farakh Ahmed Khan.
Retroperitoneal Thoraco Abdominal Fistula.
J Coll Physicians Surg Pak Jan ;9(5):234-5.

A case of retroperitoneal thoraco abdominal fistula is reported in a 23 years old young male. Pain and swelling in the left lumbar region were the main complaints. There was left sided perinephric fluid collection along with same sided pleural effusion. Aspiration of perinephric fluid collection resulted in complete resolution of pleural effusion .

CASE REPORT: A 23 years old male of average built presented with pain and swelling in left lumbar region. There were no associated symptoms. On clinical examination a tense, non tender swelling occupying whole of the left lumbar region extending to left hypochondrium and left iliac region was found. On investigation ESR was 125 mm in 1st hour. Blood urea and serum creatinine were also within normal limits. Urine examination showed proteinuria. X-ray chest showed pleural effusion on left side. The left kidney was reported enlarged with increased echogenecity. Intravenous urography revealed a soft tissue mass in the left side of the abdomen with loss of left psoas shadow. Right kidney showed normal excretion of contrast with duplex system while left kidney showed distorted pelvicalycal system. Diagnostic aspiration of left perinephric space along left sided pleural tap was done. Macroscopic, microscopic and biochemical examination of the transudate showed no malignant cell. Drainage tube was placed in left perinephric space percutaneously under ultrasound guidance. It drained about seven liters of clear fluid in 4 days. X-ray chest was repeated which showed complete resolution of pleural fluid with full expansion of left lung. At two months follow up IVU showed normal excretion on both sides. Ultrasonography revealed no fluid in perinephric space.

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