Introduction:

Pyonephrosis is the accumulation of purulent material in the pyelocalyceal system caused by total occlusion of the ureter. When untreated, it can be complicated by spontaneous ruptures that in very rare cases lead to pyelocutaneous fistulas. Its relationship with liver abscesses is even more rare. An unusual clinical case is presented that manifested with simultaneous pyelohepatic and pyelocutaneous fistulas.

Clinical case:

A 38-year-old female patient with a diagnosis of staghorn kidney stones went to the emergency department due to discharge of secretion through the abdominal wall for 7 days. Imaging studies reported liver abscess and anterior abdominal wall abscess. She was taken to the operating table where a pyelocutaneous fistula was evident located on the ventral aspect of the right kidney, directed towards liver segment VIII and planes of the anterior abdominal wall. Conclusion: Simultaneous pyelohepatic and pyelocutaneous fistulas as a complication of pyonephrosis are such an unusual clinical entity that no cases have been reported in the literature. Now that it has been described, early diagnosis is key to the patient’s survival.