Diagnosis and treatment of tumor-associated gastrocolic fistula: a report of 4 cases / 国际外科学杂志

Objective To explore the diagnosis and treatment of tumor associated gastrocolic fistula (GCF).Methods The records of the 4 patients with GCF between August 2008 to February 2014 were retrospectively analyzed.Three female and one male patients,those whose average age were 61 years,have been pathologically diagnosed postoperatively as gastrocolic fistula caused by malignant diseases.The main clinical symptoms were diarrhea (3 cases),fecal vomitus (3 cases),weight loss (4 cases),and abdominal pain (4 cases).Positive diagnostic tests for GCF included gastroscope (3 cases),colonoscope (1 case),barium enema (1 case),upper gastrointestinal contrast (2 cases).Results En-bloc resection of the involved gastrocolic region have been performed for all,2 patients underwent radical gastrectomy and colon resection and 2 patients were taken on palliative procedure.Pathology indicated adenocarcinoma all,Immunohistochemical detection for CK20,CDX-2 were applied for identifying the originations of tumors.Delayed gastric emptying and DIC occurred in one patient who died in 3 months after the operation,anastomotic leakages were found in 2 cases.The survival patients were all discharged and taken capecitabine combined with Oxaliplatin for chemotherapy.Conclusions Endaoscopy and gastrointestinal imaging are main evidences for diagnosis of GCF.En-bloc resection of the involved gastrocolic region were recommended,enterostomy was safer than entero-anastomosis in one stage procedure.The originations of tumors may be identifying according to the pathological characteristic and CDX-2,CK20 staining.Adjuvant chemotherapy should be applied.

A Case of Gastrojejunocolic Fistula as a Complication after Gastrojejunostomy / 대한소화기내시경학회지

Gastrocolic and gastrojejunocolic fistula are well-recongnized but rare complications of a variety of diseases, and surgical or endoscopic procedures We had a case of gastrojejunocolic fistulae associated with marginal ulcer following gastrectomy with Billroth II gastrojejunostomy for recurrent peptic ulcer disease. He had chronic watery diarrhea, weight loss and fecal eructation and gastrojejunocolic fistula was dignosed by gastroscopy, barium enema, upper gastrointestinal series and abdominal CT scan. He underwent subtotal gastrectomy with Roux-en-Y gastrojejunal anastomosis and en-bloc resection including the fistula and surrounding colon, jejunum and gastric segments. Hereafter, he showed disappearance of diarrhea, along with slow rate of weight gain.

A Case of Gastrocolic Fistula by Primary Colon Cancer

A gastrocolic fistula is a fistulous communication between a segment of colon and the stomach. It is a rare complication and is caused most commonly by a carcinoma of the colon or the stomach. Among the less common causes of a gastrocolic fistula are a benign gastric ulcer, chronic ulcerative colitis, Crohn's disease, a carcinoid tumor, syphillis, an intraabdominal abscess, a lymphoma, trauma, intestinal tuberculosis, and iatrogenic factors. Recently, the incidence of gastrocolic fistulas has decreased due to earlier diagnosis and treatment of stomach and colon cancer. The classic triad of symptoms are lienteric diarrhea, feculent vomiting, and foul eructations, but all patients do not necessarily present with these symptoms. A gastrocolic fistula is usually diagnosed by using a barium enema, but occasionally can be detected by using an upper gastrointestinal series or endoscopy. Here, we report experience with a fistula between a cancerous transverse colon and the stomach and give a review of the literature.

A Caae of Gastrocolie Fistula Secondary to Benign Gastric Ulcer / 대한소화기내시경학회지

Gastrocolic fistula is a rare lesion which is caused most commonly by carcinoma of colon or stomach. The less common causes of gastrocolic fistula are follows: trauma, faulty gastrocolic anastomosis during gastrectomy, benign gastric ulcer, syphilis, carcinoid tumor, tuberculosis, intraperitoneal abscess, lymphoma, perforated diverticulum of colon, and ulcerative colitis. The locations of fistulae are mostly between greater curvature of stomach and distal half of the transverse colon. In the case of penetrating benign gastric ulcer and gastrcolic fistula, it is usually associated either with asipirin or with prolonged steroid administration. A 36-year-old male who had an unusual gastrocolic fistula secondary to non-surgically treated benign gastric ulcer is presented. The exitence of a gastrocolic fistula was dernonstrated by radiological examination of the colon and the stomach. In this patient, the colonoscope passde through the fistula and the stomach could be examined. Careful preparation was carried out preoperatively with intravenous fluids and blood transfusions. Resection of the distal stomch, fistulous tract, and segment of the transverse colon was then accamplished.

A case of combined gastrojejunal and gastrocolic fistula secondary to gastric cancer

A rare case of gastric cancer associated with gastrojejunal and gastrocolic fistula is presented. A 56-year-old man who had been diagnosed with advanced gastric cancer(Borrmann's type III) 5 months previously was admitted due to watery diarrhea and frequent vomiting for 2 weeks. Fluoroscopic examination was visualized two abnormal passage of contrast medium from the stomach, one to the colon, and the other to the jejunum. Gastrofiberscopy revealed that the tumor on the great curvature of the body appeared to penetrate into the colon, while the other one on the antrum directly invaded into the jejunum. The patient was treated conservatively with total parenteral nutrition and pain control.