Gastrocolic fistula with pyloric stenosis and benign gastric ulcer

We have reported a case of gastrocolic fistula with gastric outlet obstruction as a complication of benign gastric ulcer. The single-stage surgical procedure described resulted in a successful outcome. Benign gastric ulcer currently appears to be the most prevalent cause of gastrocolic fistula.     

Gastrocolic fistula complicating benign unoperated gastric ulcer. Report of four cases and review of the literature.

Of 957 patients undergoing operation for benign gastric ulcer and its complications from 1965 through June 1975, 90 had perforated ulcers. Among these were four patients in whom a gastrocolic fistula had formed. Although two of the four patients had symptoms due to peptic ulcer dating back 12 and 68 months, symptoms of a gastrocolic fistula were the initial presentation of ulcer disease in the other two. All four patients had watery diarrhea and weight loss, and barium enema examination was diagnostic in each case. The perforating ulcers were located in the distal stomach on the greater curvature in all four patients. Although enterostasis was not present in these cases, regurgitation of colonic contents probably results in bacterial overgrowth in the small intestine, causing structural and functional damage to the mucosal cells by bacterial products, manifested clinically by diarrhea in 75% of the patients. Surgery should be advised in all cases after adequate preparation of the patient; bowel preparation with cathartics, enemas, and oral antibiotics is mandatory. The preferred operation is one-stage enbloc hemigastrectomy and resection of the involved segment of colon along with the fistulous tract. The present series brings to 43 the total number of cases of gastrocolic fistulas complicating benign, previously unoperated gastric or duodenal ulcers. There is an appreciable mortality associated with this condition - 7 of these 43 patients (16%) died as a direct consequence of their fistula.     

Unusual causes of gastrocolic fistula

1. Three cases of gastrocolic fistula of unusual cause are presented. These include one patient each with carcinoma of the left kidney, gastric lymphoma, and granulomatous colitis.
2. The relationships between the kidneys and gastrointestinal tract are illustrated by a cadaveric crosssection.
3. The wide variety of diseases resulting in gastrocolic fistula is discussed.
4. Careful fluoroscopic and radiographic study may be necessary to detect the site of the fistula and to identify its cause.

     

Iatrogenic gastrocolic fistula associated with non-steroidal anti-inflammatory drug administration

An unusual case is presented of a benign gastrocolic fistula occurring in a 70-year-old man treated with piroxicam for arthritis for a period of only two months. This report illustrates that significant upper gastrointestinal complications can occur, even with short-term treatment, with non-steroidal anti-inflammatory drugs (NSAIDs).     

La fistule gastrocolique: complication exceptionnelle de la maladie ulcère gastrique

A gastrocolic fistula is a rare complication of gastric ulcers (with only 37 reported cases present in the literature). It is characterised by three main symptoms: diarrhoea, vomiting of faeculant material and weight loss. Diagnosis is confirmed through imaging and an endoscopy. Surgery remains the traditional method of treatment. We are reporting on a new observation, with a review of the literature of different epidemiological, clinical, paraclinical and therapeutic aspects of this complication.     

Fistula Secondary to Unoperated Benign Gastroduodenal Ulcer

The physician must be prepared to recognize bizarre fistulas complicating benign gastroduodenal ulcer and occurring without previous gastric surgery. A benign, often subclinical ulcer crater may suddenly perforate any hollow structure in the upper abdomen or lower chest. The consequences may be remarkably benign or immediately calamitous, depending on the anatomy of the resulting fistula.     

Gastrocolic fistula presenting as acute diarrhea

Abdominal pain, diarrhea, weight loss, vomiting, foul eructation, feculent vomiting and melena are among the presenting symptoms of patients with a gastrocolic fistula. A routine physical examination is useful in ruling out the more common causes of the presenting complaints. Barium enema shows the gastrocolic fistula in 90 to 100 percent of cases. En bloc resection of the stomach and colon is the treatment of choice. Alternative therapies include a temporary diverting colostomy, total parenteral nutrition and antacid therapy.     

Gastrojejunal fistula: a complication of peptic ulcer disease

Spontaneous gastrojejunal fistula formation is rare and its differential diagnosis multifactorial. Precise etiologic determination is necessary for proper management. We have reported a case typical of gastrojejunal fistula due to peptic ulcer disease. In contrast to the gastrocolic fistula, symptoms of the gastrojejunal fistula are those of the ulcer diathesis itself. The preferred management is by en bloc one-stage resection after preoperative colon preparation.     

Computed tomography of gastrocolic ligament: involvement in malignant tumors of the stomach

Background This study investigated computed tomographic (CT) features and anatomic bases of gastrocolic ligament involvement in malignant neoplasms of the stomach. Methods We retrospectively reviewed CT scans of 34 patients known to have gastric malignant neoplasm and gastrocolic ligament involvement. Emphasis was placed on direct invasion, lymph node metastasis, and omental seeding. Results CT manifestations of gastrocolic ligament involvement included direct invasion (38.2%, 13 of 34), enlargement of lymph nodes (50%, 17 of 34), “smudged” appearance (26.5%, nine of 34), “omental caking” (5.9%, two of 34), cystic mass (2.9%, one of 34), and varices of the omentum (2.9%, one of 34). We also found that gastric carcinoma and gastrointestinal stromal tumor invaded the transverse colon through the gastrocolic ligament in six patients (17.6%, six of 34). Conclusion CT scan is useful for detecting gastrocolic ligament involvement in gastric malignant neoplasm. The imaging features consist of a mass sign, enlargement of lymph nodes, smudged appearance, omental caking, and so on. Gastric malignant neoplasm also may involve the transverse colon through the gastrocolic ligament.     

Diagnosis of Gastrocolic and Gastrojejunocolic Fistulas

An infrequent complication following posterior gastroenterostomy for peptic ulcer is gastrocolic or gastrojejunocolic fistula. Diagnosis is established by means of a barium enema; a barium meal usually does not demonstrate the fistula.

A case of gastrojejunocolic fistula is reported in which a fistulous tract extended from the sigmoid to the anterior portion of the stomach, the site of a gastrostomy for the insertion of a feeding tube.     

Primary splenic lymphoma complicated by hematemesis and gastric erosion

Gastrosplenic fistula resulting from erosion of a primary splenic lymphoma is a rare cause of massive upper gastrointestinal hemorrhage associated with benign peptic ulcer disease, gastric Crohn's disease, gastric adenocarcinoma, and primary gastric and splenic lymphomas. Upper intestinal hemorrhage can be successfully treated with splenic artery embolization, followed by splenectory and gastric resection.     

Gastrocolic fistula as a cause of persistent diarrhea in a patient with a gastrostomy tube

Joo YJ, Koo JH, Song SH. Gastrocolic fistula as a cause of persistent diarrhea in a patient with a gastrostomy tube.A 60-year-old man with a history of recurrent strokes secondary to moyamoya disease underwent insertion of a percutaneous radiologic gastrostomy tube because of severe dysphagia. Feeding was continued for 5 months after the procedure without complications. Persistent diarrhea began 2 weeks after admission for comprehensive rehabilitation. Conservative treatment was not effective. Sigmoidoscopy showed a U-shaped tube suggestive of a gastrocolic fistula in the transverse colon. This was confirmed by means of a tubogram obtained through a gastrostomy tube. The diarrhea resolved after changing the gastrostomy tube. This case report highlights the importance of considering other uncommon conditions, such as a gastrocolic fistula, in the differential diagnosis of persistent diarrhea in a patient with a gastrostomy tube.     

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.     

Robot‐assisted surgery and endoscopic management of gastrocolic fistula: A rare complication of acute pancreatitis in a patient who had undergone sleeve gastrectomy

Ten years after undergoing sleeve gastrectomy, a 39‐year‐old man developed pancreatitis and, after recovery, presented with severe diarrhea. An image study showed barium contrast passing from the stomach to the colon. Before surgery, initial treatment consisted of parenteral nutrition and antibiotics. The patient then underwent robot‐assisted resection of a gastrocolic fistula and omentoplasty. However, 72 h after surgery, the amount of suction drainage suggested that the fistulous track repair was leaking. Therefore, we decided to perform endoscopy to place a self‐expanding covered stent at the gastroesophageal junction as well as a nasojejunal tube to continue nutritional supplementation. After the patient had fasted for 2 weeks, there was no evidence of leakage in the image studies. The patient was discharged after he had clinically improved, and the stent was removed at the end of 8 weeks. The combination of robot‐assisted surgery and endoscopic management is effective for treating gastrocolic fistula.     

胃和结肠CT仿真内镜临床应用的初步研究

目的　探讨ＣＴ仿真内镜成像技术在胃和结肠的临床应用价值。方法　对１９ 例螺旋ＣＴ 扫描的容积数据运用Ｎａｖｉｇａｔｏｒ 软件进行仿真内镜成像,并与纤维内镜及Ｘ 线钡剂检查进行对照。正常７ 例,病变１２ 例,其中进展期胃癌７ 例,早期胃癌１ 例,胃底球形静脉曲张１ 例,结肠癌２ 例,结肠腺瘤１ 例,均经手术病理或纤维内镜证实。结果　ＣＴ仿真内镜能清楚显示胃、结肠正常结构、粘膜皱襞异常、管腔狭窄、肿块及溃疡,准确对胃癌进行分型。结论　仿真内镜可获得类似纤维内镜的检查效果,可作为胃和结肠纤维内镜及Ｘ线钡剂检查的一种补充方法     

胰源性区域性门静脉高压的MRI表现

目的：探讨胰源性区域性门静脉高压（PSPH）的MR特点及临床意义。方法收集2005年5月～2012年12月73例PSPH患者的MRI图像,包括T1 WI双回波序列,轴位T2 WI压脂序列及轴位和冠状位多期动态增强扫描序列（LAVA）,分析原发病灶、脾静脉及侧支循环的MR表现。结果73例PSPH均表现为脾静脉狭窄、闭塞、中断。（1）胃冠状静脉（GCV）入口未受累的52例中,胃冠状静脉迂曲扩张43例、胃短静脉（GSV）扩张52例、胃网膜静脉（GEV）扩张52例、胃结肠干（GCT）迂曲扩张30例,食管静（esophageal vein,EV）迂曲扩张2例,脾静脉-（左）肾静脉交通支3例;（2）胃冠状静脉入口受累的21例病例中,胃冠状静脉、胃短静脉、胃网膜静脉及胃结肠干均迂曲扩张,食管静脉迂曲扩张16例,脾静脉-（左）肾静脉交通支19例。结论 MR可显示胰腺原发病灶及其相关的胰源性门静脉高压的侧支循环特点。     

腹腔镜胃良性肿瘤手术28例报告

目的 探讨腹腔镜在胃良性肿瘤手术中的应用。方法 对28例胃良性肿瘤在腹腔镜下实施手术。其中胃平滑肌瘤23例、神经纤维瘤3例、脂肪瘤2例。根据肿瘤直径和部位，分别行胃楔形切除（17例）和胃大部切除术（11例）。结果 28例手术均获成功。26例手术在完全腹腔镜下完成，2例行手助腹腔镜手术，手术平均140min（60-310min），平均出血量160mL（80-400mL），无吻合口瘘、术后大出血等并发症发生。术中均送快速冰冻明确病变为良性，且得到常规病理证实。结论 腹腔镜手术对治疗胃良性肿瘤是可行的，在不断积累经验的基础上，腹腔镜胃手术必将得到更快的发展。     

Recurrent anal fistulas: When,why, and how to manage?

Anal fistula is a commonly encountered anal condition in the surgical practice.Despite being a benign condition,anal fistula remains to represent a surgical challenge,particularly the complex type of fistulas.One of the common complications of anal fistula surgery is the persistence or recurrence of the pathology,both defined as failure of surgery.Recurrent anal fistulas after previous surgery represent an even more challenging problem since they are usually associated with a higher risk of re-recurrence and continence disturbance.The present review aimed to shed light on various aspects of recurrent anal fistulas,including the different definitions of failure after surgery,risk factors of recurrence,problems associated with management of recurrent fistulas,and assessment and treatment of recurrent anal fistulas.     

Pancreatic fistulae (author's transl)]

The incidence of postoperative persistent external fistulae following inflammatory or traumatic lesions of the pancreas has increased over the past years. The choice of the optimum time for surgical rectification of this condition, as well as the operative technique is discussed in this review of the literature and 11 cases treated under our care over the past 15 years. It appears advisable 1) not to wait longer than about 6 weeks to carry out operative closure of the fistula (this period of time being necessary for the fistula to develop by granulation), 2) to undertake fistulo-jejunostomy with long section of the canal of the fistula, if possible, especially when applying the "pull through" method and 3) to place, if possible, the drainage tubing along the gastrocolic ligament, during the initial operation thereby selecting the most advantageous site for the development of any subsequent fistula.     

Multicentric early gastric carcinoma mimicking type I (10 years after B-I-surgery).

10 YEARS AFTER B-I-partial gastrectomy for a proven benign gastric ulcer a multicentric early gastric carcinoma type II b, c was detected by endoscopy and histology. This early carcinoma differed from published cases in respect of its macroscopic classification, localization and expansion. The carcinoma situated next to the anastomosis invaded the duodenal mucosa. It also invaded a polypoid fold caused by the previous surgery, thus imitating an early gastric carcinoma type I.