DUODENO-URETERAL FISTULA OF SPONTANEOUS ORIGIN

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Abstract
The proximity of the duodenum to the right renal pedicle, and the danger of injury to the former during nephrectomy, have been pointed out by Dr. W. J. Mayo,1who cites four cases of duodenal fistula following nephrectomy, the first three of which were fatal, the fourth being cured by transperitoneal closure of the duodenum. The case reported herewith is doubly interesting in that it further emphasizes this danger of duodenal injury during nephrectomy, and presents a most unusual (and apparently unique) condition, namely, a definite demonstrable fistula connecting duodenum and ureter,which existed before any operative procedure had been carried out. REPORT OF CASE History. —A man, aged 29, complained of dull, aching pain in the right flank of four years' duration, and of extreme frequency of urination, urgency and bladder irritability. There was nothing of importance in his history up to four years before admission, at which

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