A 56 year old female presented to our metropolitan hospital in July 2023 with right flank pain and fever. She was found to have a UTI and CT showed right sided hydronephrosis presumed to be due to her uterine fibroids. She had a right sided ureteric stent inserted and a plan was made for her to have a hysterectomy to definitively treat her fibroids. In October her stent was removed and she was noted to have recurrent UTIS and candida. She had a follow up CT IVP which showed persistent hydronephrosis. Subsequent investigation of her scan showed a foreign body likely a fishbone presented within the gastro-intestinal tract thought to be fistulating into her kidney. Rigid cystoscopy and RGP showed contrast within the duodenum confirming the presence of fistulation. She had a gastroscopy which was successful in removing the foreign body which was identified to be a toothpick.

 

 

Whilst digestive tract foreign bodies are relatively common occurrences, migration into other organs is rare but dangerous and an important differential to consider. Unfortunately, there was a six month period until eventual diagnosis for our patient. During which she had multiple minor operations and a major operation; a hysterectomy. Throughout this time she also had multiple CT scans none of which reported the presence of a foreign body. Her delay in correct diagnosis is likely due to the presence of generalised urinary sepsis symptoms and the lack of history of foreign body ingestion.