Pyeloduodenal Fistula in Xanthogranulomatous Pyelonephritis
Bibliographic record
Abstract
A 48-year-old otherwise healthy woman with recurrent urinary tract infections presented to the emergency department with 1 month of fever and flank tenderness. Three months prior, she was diagnosed with a 3-cm right staghorn stone; interventions were postponed due to the SARS-CoV-2 pandemic. Percutaneous nephrolithotomy was attempted: unexpectedly, dye injected into the ureter filled the bowel on fluoroscopy, suggesting a renal-enteric fistula (a). Computed tomography demonstrated xanthogranulomatous pyelonephritis (XGP), a rare chronic pyelonephritis, with perinephric stranding abutting a thickened duodenum. Endoscopy was performed to plan for intervention, revealing a fistulous opening in the second segment of the duodenum (b). Pyeloduodenal fistula is an extremely rare, late-presenting sequela of XGP (1). Definitive management traditionally involves primary surgical fistula closure with nephrectomy (2). Endoscopy facilitates fistula localization; furthermore, with the advent of Over-the-Scope-Clips (OTSC) for fistula closure, endoscopic approaches should be considered first as a safe, feasible alternative to surgery. There are two reported cases of pyeloduodenal fistula closure using OTSC (3,4). Endoscopic intervention was considered here; however, given the patient’s significant renal involvement, she underwent nephrectomy with concurrent surgical clipping of the fistulous tract. Pathology revealed abscesses and necrosis infiltrating the renal parenchyma. Post-operatively, she required parenteral antibiotics and remained well 6 months post-discharge. Informed consent was obtained from the patient for the publication of their information and imaging without any identifying information. All authors have made substantial contributions to all of the following (1) conception and design, (2) drafting and revising the text, and (3) final approval of the version to be submitted. The authors have no personal or financial conflicts of interest to disclose.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".