Gastrojejunocolic Fistula Occurring after Billroth-II Subtotal Gastrectomy

ABSTRACT

Gastrojejunocolic fistula (GJCF) is mainly thought to be a late complication of inadequate gastric surgery such as insufficient gastric resection or inappropriate vagotomy. The pathogenesis of fistula formation has been accounted to the perforation of a retained jejunal marginal ulcer into the transverse colon. Most patients with GJCF present a common symptom triad of faecal vomiting, chronic diarrhea and weight loss. We recently experienced a patient with GJCF who had been suffering from diarrhea for a long period of time. He had undergone gastric surgery 8 years previously for peptic ulcer disease at another hospital. After detailed preoperative evaluation with duodenoscopy, upper gastrointestinal series, colonofiberscopy, barium enema and abdominal CT, he underwent surgery-resection of the gastric stump and segmental resection of the jejunum and transverse colon with Roux-en-Y gastrojejunostomy. Recent advances in surgical technique such as vagotomy, and medical therapy have remarkably decreased the incidence of both stomal ulcer and GJCF in peptic ulcer disease. However, gastrojejunocolic fistula should be recognized as one of the late severe complications observed after a gastrectomy with Billroth-II reconstruction, since this disease may occur even 20 years after the first operation. We report the case of a 52-year old man with gastrojejunocolic fistula with review of the literature.