An unusual case of nephrocutaneous fistula

An 86-year-old Caucasian woman presented with a 2-day history of a painful swelling in the left upper thigh anteriorly. She also gave a recent history of recurrent urinary tract infection associated with macroscopic haematuria, against a background of a long-term indwelling catheter for complete urinary incontinence. She denied any change in bowel habit and her weight had also been stable. Her past history included a hysterectomy, dynamic hip screw insertion for fractured right neck of femur and coronary artery disease. On examination she was apyrexial with no signs of anaemia, jaundice or lymphadenopathy. The left thigh swelling was confirmed to be an abscess. Abdominal and rectal examinations were unremarkable. The abscess was subsequently incised and drained. A substantial amount of pus was released. Culture of the pus yielded Proteus and Escherichia coli. Unfortunately the left thigh wound failed to heal up completely resulting in a constantly discharging sinus (Figure 1). A sonogram was then performe...