THE TRACK THAT NO ONE EXCEPTED- A DUODENAL RENAL CYST FISTULA

Objectives: 67 year old male with hypertension, heart attack, possible stroke, schizophrenia (difficult historian) and known right renal cyst presented with worsening and pain and nausea/vomiting for four days. Patient reports he has not been able to keep fluids or solids down. Pain does not localize. CT scan shows possible duodenal ulcer tracking into renal cyst with no free air. Reports continued bowel movements once a day. Drain placed by interventional radiology (IR) after hospital admission to assist with drainage, high volume output. An esophagogastroduodenoscopy was performed for jejunal feeding tube placement. The patient had multiple issues during his hospital stay from his schizophrenia including pulling his nasogastric tube twice and he was eventually discharged because he was refusing treatment. Surgical planning was in process to continue distal feeds and hepatobiliary surgery and urology were contacted for input. The patient was lost to follow up and attempts to contact were not successful. This case speaks to the challenge of treating patients with mental health disorders. Even with appropriate medication, the level of medical understanding was difficult for the patient. Most of the time, while discussing his medical issue, smaller acute problems were at the forefront of his mind. Multiple resources were used to assist with explanation but ultimately, the patient made his decision to go home. Mental health disorders play a large role in surgery and post surgical care.

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