Gastrocolic Fistula Due to Benign Gastric Ulcer

Perforation of a benign gastric ulcer is the rarest cause of a gastrocolic fistula. The rarity of such a case is compounded when formation of the gastric ulcer is not induced by steroid medication. Two patients with this type of gastrocolic fistula are presented along with a brief review of the few previously reported cases.     

Gastrocolic fistula secondary to diverticulitis of the splenic flexure: Report of a case

Summary A gastrocolic fistula was demonstrated on barium-enema examination of a patient with recurrent left upper abdominal pain. The underlying cause proved to be perforated diverticulitis of the splenic flexure. This unusual etiology may be considered when the radiologic evidence for gastrocolic fistula and colonic diverticula occur together.     

Case report: gastrocolic fistula mimicking Zollinger-Ellison syndrome.

Fasting serum gastrin levels greater than 1000 pg/ml are said to establish the diagnosis of gastrinoma in a patient with peptic ulcer disease. The authors observed a patient with recurrent peptic ulcer disease, diarrhea, and a fasting serum gastrin of 1044 pg/ml who had a gastrocolic fistula, not the Zollinger-Ellison syndrome. The provocative tests of gastrin secretion, including secretin infusion and standard meal test, were helpful in ruling out a gastrinoma. This is the first reported association of gastrocolic fistula and hypergastrinemia. The patient demonstrates that the differential diagnosis of markedly elevated serum gastrin should be expanded to include gastrocolic fistula.     

The gastrocolic trunk of Henle in pancreatic surgery: an anatomo-clinical study

From 37 peroperative and cadaver anatomical investigations, it was concluded that, in contrast to the information in common texts on anatomy and surgery, a venous gastrocolic trunk was observed in only 46% of subjects; a true bipod gastrocolic trunk of Henle was a rare (8%) phenomenon. In this respect, a variate venous anatomy at the inferior border of the neck of the pancreas, as observed in this study, must be taken into account during pancreatic surgery and radiological procedures in the pancreas.     

The management of Crohn's colitis with colonogastric fistula

Colonogastric fistula, more commonly called "gastrocolic," is a rare complication of Crohn's colitis. The 17th incidence of this fistula is reported. Fecal halitosis is a prominent symptom. Barium enema is the most accurate diagnostic tool. Colonoscopy plays a role in delineating surgical therapy. The stomach resection is described. Because of its pathogenesis, the authors prefer to call this "colonogastric" fistula, rather than gastrocolic fistula.     

The debut of Crohn's disease as a gastrocolic fistula

The case of a 66-year-old women admitted for the study of chronic diarrhea and an important deterioration in her general state is reported. Following the study undertaken the presence of a gastrocolic fistula was observed without clarifying the nature of the same thereby leading to surgical treatment. Anatomopathologic analysis confirmed the presence of a gastrocolic fistula in relation to Crohn's disease. The origin of these fistulas is usually neoplastic and the presentation as a complication of an inflammatory disease is very infrequent.     

Venous anatomy of the right colon: precise structure of the major veins and gastrocolic trunk in 58 cadavers

PURPOSE: This study was designed to describe the precise venous anatomy of the right colon, which is especially important for laparoscopic right hemicolectomy. METHODS: Fifty-eight adult cadavers were dissected to define the three major venous tributaries of the right colon: the ileocolic vein, right colic vein, and middle colic vein. Two or three middle colic veins were often present, and the biggest one was designated as the main middle colic vein. The middle colic vein and the right colic vein occasionally formed a common trunk with the right gastroepiploic vein and/or the pancreaticoduodenal vein. This common trunk was defined as the gastrocolic trunk. RESULTS: All 58 cadavers had a single ileocolic vein. All of the ileocolic veins drained into the superior mesenteric vein. The right colic vein was absent in 56.9 percent (33/58), and the other 43.1 percent had a single right colic vein. The right colic vein joined the superior mesenteric vein directly in 56 percent (14/25) and the gastrocolic trunk in 44 percent (11/25). The middle colic vein was the most variable. A single middle colic vein was present in 37.9 percent (22/58), 2 middle colic veins were present in 50 percent (29/58), and 3 middle colic veins were present in 12.1 percent (7/58). The main middle colic vein drained into the superior mesenteric vein directly in 84.5 percent (49/58), whereas 12.1 percent (7/58) drained into the gastrocolic trunk. In two cadavers, there was anomalous drainage of the main middle colic vein to the splenic vein and the inferior mesenteric vein. Forty-three accessory middle colic veins were present in total. These drained into the superior mesenteric vein in 17 cadavers and into the gastrocolic trunk in 23. The gastrocolic trunk was present in 69 percent (40/58), being formed with the right colic vein in 27.5 percent (11/40; 1 was together with an accessory middle colic vein) and with the middle colic vein in 75 percent (30/40; 7 with the main middle colic vein, 23 with the accessory middle colic vein). CONCLUSION: Venous anatomy of the right colon is highly variable. It is especially important to recognize the lack of direct drainage of the right colic vein to the superior mesenteric vein and the high frequency of the presence of plural middle colic veins and the gastrocolic trunk.     

复方抗瘤冲剂对老年胃肠道肿瘤患者免疫功能的影响

目的:评价复方抗瘤冲剂配合静脉化疗对老年胃肠道肿瘤患者免疫功能的影响.方法:老年胃肠道肿瘤患者43例随机分为两组:对照组22例,用甲酰四氢叶酸钙、5-氟尿嘧啶、丝裂霉素方案行静脉化疗;治疗组21例,在静脉化疗同时,服用复方抗瘤冲剂.化疗前及化疗2个疗程结束后(6周)分别检测外周血常规、免疫球蛋白、T淋巴细胞亚群,进行统计学分析.结果:化疗结束时治疗组患者外周血中白细胞、血小板计数、血红蛋白较化疗前无明显下降;与对照组比较,治疗组免疫球蛋白IgG、IgM及T淋巴细胞亚群CD 4、CD 4/CD 8值均有提高,两组差异均有统计学意义.结论:复方抗瘤冲剂可有效提高老年胃肠道肿瘤患者机体免疫功能,使患者平稳经受化疗.     

Adaptation of jejunal to colonic mucosal autografts in experimentally induced short bowel syndrome

The behavior of jejunal to colonic mucosal autografts was studied in an experimental animal model of short bowel syndrome (SBS). Histological appearances, enterocyte enzyme activities, and in vitro glucose transport were studied at the donor and recipient graft sites in control, short-bowel syndrome, and gastrocolic fistula 5-week-old Sprague-Dawley rats. Small intestinal function was maintained in the jejunocolonic graft after 80% small bowel resection; animals in which small bowel was not resected showed loss of graft function and enzyme activity. This effect is dependent on the presence of jejunal chyme: after gastrocolic fistulae, the jejunum to colon grafts lost jejunal functional activities. Total parenteral nutrition did not alter graft behavior but improved the postoperative mortality of the procedures. The results provide additional information on intestinal adaptation in SBS.     

Gastrocolic Fistula in transverse colon cancer

Fistula formation between the stomach and the colon secondary to a neoplastic process was first reported by Haller in 1775. We report a case of a 77-year-old woman with a gastrocolic fistula originating from a transverse colon cancer. Reports in literature are very rare and show a poor prognosis even for those patients who underwent a radical operation.     

Colobronchial and gastrocolic fistulas: rare complication of Crohn's disease

A rare case of colobronchial and gastrocolic fistulas originating from the splenic flexure in a patient with Crohn's disease is presented. A computed tomographic (CT) examination of the chest first suggested the presence of the colobronchial fistula.     

多层螺旋CT对胰源性区域性门静脉高压的诊断价值(附42例报道)

目的 分析胰源性区域性门静脉高压(pancreatogenic segmental portal hypertension,PSPH)的多层螺旋CT(MSCT)表现,探讨MSCT对该病的诊断价值.方法 使用16排螺旋CT对42例PSPH患者行上腹部CT平扫及增强扫描,采用图像后处理技术显示脾静脉及侧枝血管情况.结果 孤立性脾静脉阻塞30例,其侧支血管食管静脉(9.5%)、胃冠状静脉(76.19%)、胃短静脉(85.71%)、胃网膜静脉(95.24%)、胃结肠干(23.81%)曲张;非孤立性脾静脉栓塞12例,其中伴肠系膜上静脉阻塞8例,其属支胃结肠干(19.05%)、结肠右上静脉(16.67%)、结肠中静脉(14.29%)、胰十二指肠前上静脉(19.05%)有不同程度曲张.伴门静脉海绵样变5例.结论 MSCT对PSPH的脾静脉阻塞及其胃周迂曲扩张的侧枝静脉显示具有重要价值.     

Gastrocolic fistula secondary to benign gastric ulcers

Summary and Conclusions A fistula between the greater curvature of the stomach and the midportion of the transverse colon usually is an ominous condition. If there is no history of previous surgery, it is likely that a diagnosis will be made of a gastrocolic fistula secondary to a primary carcinoma of either the stomach or the colon. However, as shown in this paper, a spontaneous fistula may develop between the stomach and the transverse colon in a patient with a benign unoperated gastric ulcer. On the basis of clinical symptoms, physical examination and x-ray findings, it is not likely that a distinction can be made between a neoplastic gastrocolic fistula and one caused by an inflammatory disorder. Usually the exact nature of the underlying pathologic process can be made only at the time of exploratory laparotomy. Preoperative preparation of the patient is important and must include correction of fluid andelectrolyte imbalance, treatment of any existing anemia and malnutrition, and adequate mechanical bowel preparation. The surgical procedure of choice, in our experience, isen bloc resection of the distal half of the stomach, thefistulous tract, the adjacent inflammatory tissue, and resection of the involved portions of the transverse colon and omentum. Gastrointestinal continuity can be re-established by a Billroth 1 type of gastroduodenostomy and end-to-end anastomosis of the transverse colon. Important technical points involved in the surgical procedure include exercising care to avoid injury to the pancreas and midcolic artery while freeing the adhesions around the inflammatory mass, and interposition of a wedge of omentum between the gastric and colonic suture lines. Two cases of spontaneous gastrocolic fistula secondary to benign unoperated gastric ulcers are reported.     

Free perforation of benign gastrojejunocolic and gastrocolic fistula

Free perforation of a primary, benign, gastrocolic fistula is extremely rare; perforation of a gastrojejunocolic fistula has not been reported previously in the English medical literature. Experience with two such cases is presented and the surgical management of this condition is emphasized.     

Gastrocolic fistula - a rare cause of cachexia and polyneuropathy

Gastrocolic fistula is a rare clinical disorder which in the past most often occurred after gastric surgery or carcinoma of the gastrointestinal tract. However, during the last decade an increasing number of cases after benign gastric ulcers have been described. Most common symptoms have been weight loss, abdominal pain, diarrhea and copremesis. A 49-year-old cachectic patient presented with a 2-year history of abdominal discomfort and diarrhea. He reported a weight loss of 32 kg during this period and was finally unable to move because of exhaustion. Furthermore, he suffered of burning paresthesia of the legs and the abdomen. His medical history included a Billroth II operation because of recurrent ulcer disease in 1987. Barium enema revealed a gastrocolic fistula which caused small bowel bacterial overgrowth with villous atrophy and malabsorption and development of polyneuropathy. The fistula was surgically resected, and postoperatively, the patient improved and regained his weight. Gastrocolic fistula is a rare cause of diarrhea and should be considered in clinical practice. Barium enema is superior to endoscopy in detecting gastrocolic fistula.     

Enterocolic fistula: A rare presentation of cytomegalovirus infection

In the present report, the first reported case of cytomegalovirus (CMV)-associated enterocolic fistula in an HIV/AIDS patient is described. CMV colitis is the second most common presentation of CMV infection in immunocompromised patients. CMV-associated enteric fistulae are an exceedingly rare complication, with only four previous cases described: a gastrocolic, an enterocutaneous, a rectovaginal and a colocutaneous fistula. Management of these patient demonstrates the importance of treating the precipitating viral infection before considering surgical intervention of the enterocolic fistula.     

Gastrocolic fistulae as a consequence of benign gastric ulcer disease.

Gastrocolic fistulae are a rare entity, occurring most commonly in the context of a malignant process or less frequently as a complication of a benign gastric ulcer. Presenting symptoms tend to be nonspecific, but the diagnosis can be confirmed with near certainty by barium enema examination or an upper gastrointestinal series. Although the management of gastrocolic fistulae has historically been surgical, medical management has recently been recommended as the first line of treatment when an underlying malignancy can be excluded.     

Total pancreatectomy with segmental duodenectomy preserving right gastroepiploic vein

We performed total pancreatectomy with segmental duodenectomy preserving the gastrocolic trunk and right gastroepiploic vein, to prevent gastric venous congestion, for treatment of pancreatic tumor. This is believed to be the first report of such a procedure. The patient was a 58-year-old man with high serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen. He was examined by abdominal ultrasonography and computed tomography, and diagnosed with cancer of the pancreatic body. No distant metastasis was found. We decided to perform distal pancreatectomy. After surgery, the cut edge of the distal pancreas was subjected to frozen section examination, and there was carcinoma in situ in the stump of the main pancreatic duct. Therefore, we cut the pancreatic head partially, twice, but carcinoma in situ remained. We additionally performed pancreatic head resection with segmental duodenectomy, with preservation of the gastroduodenal artery, right gastroepiploic artery, gastrocolic trunk and right gastroepiploic vein to prevent gastric venous congestion. The postoperative course was uneventful and the patient remains in good condition. This surgical technique is considered feasible and safe for prevention of gastric venous congestion.     

Gastrointestinal/pancreatic hormone concentrations in the portal venous system of nine patients with organic hyperinsulinism

Percutaneous transhepatic sampling of blood in the portal venous system (TPVS) was used to; (1) localize hormone secreting tumors and help in differentiating tumors from diffuse disease (nesideoblastosis and hyperplasia with adenomata) in 9 patients with fasting hypoglycemia and hyperinsulinism, and (2) study the concentration an distribution of the immunoreactive peptides: insulin (IRI), gastrin (IG), glucagon (IRG), pancreatic polypeptide (hPP), and somatostatin (SRIF-LI), in the venous drainage of the uninvolved portion of the pancreas and GI tract. Localized elevations of IRI (64-920 microunits/ml) predicted tumor localization in 6 patients with single tumors that were not demonstrable angiographically. In one patient with nesideoblastosis and another with islet cell hyperplasia with adenoma, elevated IRI concentrations at multiple locations suggested a diffuse or multicentric process. Elevations of SRIF-LI in the same region as IRI elevations in one patient and of IRG in another patient suggested that these tumor produced two hormones. Some problems in the interpretation of portal venous insulin concentrations are discussed. The locations of maximum portal venous system plasma concentrations and portal-arterial gradients (mean +/- SE pg/ml) in five patients with small single insulinomas were: IG, gastrocolic trunk (126 +/- 27, 46 +/- 22); IRG, proximal splenic vein (130 +/- 30, 47 +/- 13) and gastrocolic trunk (131 +/- 23, 60 +/- 13); hPP, portal vein (164 +/- 48, 49 +/- 22); SRIF-LI, superior mesenteric vein (186 +/- 50, 57 +/- 20) and gastrocolic trunk (178 +/- 59, 55 +/- 21). It is concluded; (1) TPVS can be used successfully to localize single insulin-secreting tumors of the pancreas and to help distinguish them from diffuse disease but problems in such differentiation do occur, (2) circulating SRIF-LI and IRG are derived from both the pancreas and the gut, IG predominantly from the proximal gut and hPP from the head of the pancreas, and (3) The data provide new information for the interpretation of portal insulin concentrations in patients with organic hyperinsulinism and of hormone concentrations for localization of peptide-producing tumors of the pancreas other than insulinomas.     

The Radiology Corner

This case serves to illustrate the multiple routes which may occur in the dissemination of carcinoma of the stomach of the large bowel. Spread along the gastrocolic ligament involves the superior aspect of the transverse colon with limitation laterally by the phrenicocolic ligament. Once ascites has developed there is spread along the superior border of the sigmoid and lateral margin of the right side of the colon.