Laparoscopic Management of Gastrocolic Fistula in a Patient with a History of an Unusual Loop Gastric Bypass-a Video Vignette.

Gastrocolic fistula (GCF) is defined as an abnormal pathological communication between the epithelialized mucosal layers of the stomach and colon. In rare cases, complications following gastric bypass surgery, such as leakage or complicated marginal ulcers, may contribute to the development of a GCF. The laparoscopic approach for managing GCF involves a one-stage procedure that includes resection of the fistula and reconstruction of the gastrointestinal tract.

Benign Peptic Ulcer as a Cause of Gastrocolic Fistula.

Gastrocolic fistula is a rare complication and can occur in various conditions, most commonly gastric or colonic adenocarcinoma, followed by benign gastric ulcers secondary to nonsteroidal anti-inflammatory drug use. We report a case of an 82-year-old man with a benign peptic ulcer that led to a gastrocolic fistula, which was not associated with a history of nonsteroidal anti-inflammatory drug use or malignancy. The exact cause of this patient's gastrocolic fistula is unclear, but the patient's medical history of microscopic lymphocytic colitis may have increased his risk of fistula formation.

Fístula gastrocólica como causa infrecuente de diarrea persistente en un paciente portador de gastrostomía radiológica percutánea / Gastrocolic fistula as infrequent cause of chronic diarrhea in a patient with percutaneous radiological gastrostomy

Introducción: la fístula gastrocólica supone una complicación infrecuente pero potencialmente grave de las sondas de gastrostomía. La sospecha clínica ante una diarrea de origen incierto que comienza tras el recambio de la sonda es clave para la detección y el tratamiento precoces. Caso clínico: se presenta el caso de un paciente portador de gastrostomía radiológica percutánea (PRG) que comienza con diarrea persistente tras el primer recambio de la sonda y desnutrición grave secundaria. Tras el fracaso de las medidas terapéuticas iniciales se amplían los estudios, con hallazgo de esta complicación en la imagen de TC. Se suspende el uso de esta sonda con resolución de la diarrea y evolución nutricional favorable. Discusión: este caso pone de manifiesto la importancia de incluir la fístula gastrocólica en el diagnóstico diferencial de la diarrea persistente en un paciente portador de sonda de gastrostomía.(AU)

Introduction: gastrocolic fistula is an infrequent but severe complication of percutaneous gastrostomy. Clinical suspicion in the presence of chronic diarrhea of unknown etiology manifesting after percutaneous radiological gastrostomy (PRG) tube replacement is key to early detection and treatment. Case report: we report the case of a patient with PRG that began with chronic diarrhea after tube replacement and developed severe malnutrition. Initial treatment was not effective, studies were extended with the finding of this complication in a CT image. The use of this tube was discontinued with resolution of diarrhea and a favorable nutritional outcome. Discussion: this case report shows the importance of considering gastrocolic fistula in the differential diagnosis of persistent diarrhea in a patient with a gastrostomy tube.(AU)

Acute Necrotizing Pancreatitis Presenting as Gastrocolic Fistula: A Rare Occurrence.

Tissue necrosis and ischemia are hallmarks of acute necrotizing pancreatitis, which frequently results in fatal infections. In this case, we describe a man in his 40s who had diffuse pain in the abdomen, intractable vomiting, diarrhoea, and intermittent fever. His abdominal computed tomography revealed acute pancreatitis with peripancreatic fluid collection, gastric perforation, and fistula formation between the greater curvature of the stomach and transverse colon. His upper gastrointestinal (GI) endoscopy confirmed a gastrocolic fistula.

Gastrocolic fistula as a complication of a gastric ulcer related to Helicobacter pylori in a child.

Gastrocolic fistulas are very rare in children and their association with Helicobacter pylori is poorly described. We present the case of a 10-year-old boy with a history of chronic abdominal pain, diarrhea, halitosis, and growth delay diagnosed with H. pylori-associated gastritis and gastrocolic fistula. The boy recovered with resection surgery and antibiotic therapy for eradication of the pathogen. This is the first description of a gastrocolic fistula in pediatrics related to H. pylori.

Gastrocolic fistula caused by transverse colon cancer: a case report.

BACKGROUND: A gastrocolic fistula is an unusual communication between the colon and the stomach. Although colon cancer is the most common malignant cause of gastrocolic fistula in the Western world, the incidence of gastrocolic fistula due to colon cancer is 0.3% in operated cases. CASE PRESENTATION: A 68-year-old man presented with anorexia, general malaise, weight loss, and vomiting of fecal matter. Investigations revealed that the patient had a large nonmetastatic splenic flexure tumor that was diagnosed as colon cancer and had invaded the stomach and pancreas. An upper gastrointestinal series confirmed a gastrocolic fistula. Left hemicolectomy, distal gastrectomy, distal pancreatectomy, and splenectomy were performed. Histology revealed transverse colon cancer, which was UICC stage (8th edition) pT4bN1bcM0 pStage IIIC. Adjuvant chemotherapy was not performed. There was no recurrence or metastasis one year after surgery. We reviewed 17 cases including our case of a gastrocolic fistula caused by colon cancer. Neoadjuvant chemotherapy was not given to any of the patients, and en bloc resections were conducted in all cases. Adjuvant chemotherapy was given to almost all of the patients. There was no recurrence or metastasis. CONCLUSIONS: For gastrocolic fistula caused by advanced colon cancer, secure en bloc surgical resection was the initial treatment in all 17 reported cases including the present case, and adjuvant chemotherapy may contribute to a better prognosis.

Transcolonic misplacement as a rare complication associated with PEG tube.

PEG tube placement is a relatively safe procedure; however, complications sometimes occur. Our article will allow readers to visualize the uncommon complication of PEG - a transcolonic misplacement.

Gastrocolic fistula in Crohn's disease: A case report and review of the literature.

Gastrointestinal fistulas constitute a rare type of abdominal fistula and an uncommon complication in the setting of Crohn's disease. In this case presentation we study the treatment of a gastrointestinal fistula between the transverse colon and the stomach in a patient with Crohn's disease and present a review of the available literature. A 53-year-old female patient with history of Crohn's disease presented to the Emergency Department of our Hospital due to reported abdominal pain and clinical symptoms of incomplete ileus with no other specific symptoms. Imaging investigation included plain radiography and computed tomography of the abdomen and revealed mural thickening of the transverse colon for an approximately 10 cm long segment, with the possible presence of gastrocolic fistula. During the exploratory laparotomy, an inflammatory mass was found in the middle of the transverse colon and the communication with the stomach was confirmed. Excision of the affected part of the transverse colon and cuneiform resection of the stomach in the area of the fistula was performed. The patient presented smooth and uncomplicated postoperative period and was discharged on the 10th postoperative day. Gastrointestinal fistulas are an uncommon complication of Crohn's disease, often with an intense clinical manifestation from the upper and lower digestive tract. Surgical treatment, either open or laparoscopic, of gastrointestinal fistulas due to Crohn's disease is the "gold-standard" method, both to control the disease and avoid further complications.

Gastrocolic Fistula: An Extraordinary Gastrointestinal Fistula.

Gastrocolic (GC) fistula, a rare gastrointestinal pathological condition, is defined as an abnormal connection between the stomach and the colon. Mostly, it involves the greater curvature of the stomach and the transverse part of the colon. Its precise incidence rate is unknown and largely differs between western and eastern nations. Etiological causes differ as well between the two worlds. Although several precipitating diseases are reported, nowadays, the most common causes are malignant diseases of the stomach (eastern countries) and colon (western world). Patients with GC fistulas usually present late and complain mainly of vomiting, diarrhea, and severe weight loss. This in turn leads to malnutrition, vitamin deficiencies and electrolyte disturbances. Being a rare condition, and usually forgotten, diagnosis is usually challenging to the treating physicians. Workup usually involves a combination of radiological and endoscopic tests. Long-term survival is unknown, and patients usually have poor prognosis. The aim of this review is to summarize the relevant articles in the English literature for this abnormal medical condition, with emphasis on the different etiologies, pathogenesis, clinical presentation, and management, in order to increase physicians' awareness of such uncommon medical problem.

Gastro-cholecysto-colic fistula. Case report of an idiopathic case, and management approach.

A 71-year-old lady presented with a 4-week-history of epigastric pain, feculent vomiting, diarrhoea and weight-loss. On subsequent investigations, she was found to have a complex gastro-cholecysto-colic fistula with no clear underlying aetiology. The only abnormality both macroscopically and microscopically was ulceration and inflammation in the colon. However, this was not pathognomonic of inflammatory bowel disease, and (gastric) acid-induced inflammation is an alternative explanation. Herein we present her case, her comprehensive evaluation, her successful surgical management and a review of the relevant literature.

A Child With a Gastrocolic Fistula After Ingesting Magnets: An Unusual Complication.

Foreign body ingestion is frequently the cause of emergency visits in the pediatric population, and these cases are challenging to diagnose and manage. In particular, the ingestion of magnets is dangerous and can lead to serious complications and even death. Urgent endoscopic intervention or surgical exploration remains the best approach for removing multiple ingested magnets and preventing further injury to the gastrointestinal (GI) tract. We report a nine-year-old child with an adjustment disorder who developed a gastrocolic fistula following the deliberate ingestion of multiple magnets. The magnets were successfully retrieved after an emergency laparotomy, and the fistula was subsequently repaired.

Gastrocolic fistula in Crohn's disease detected by oral agent contrast-enhanced ultrasound: A case report of a novel ultrasound modality.

BACKGROUND: Fistulas are common complications of Crohn's disease (CD). Gastrocolic fistulas (GFs) are rare, occult and potentially life-threatening complications. Few cases of GFs have been reported. Oral agent contrast-enhanced ultrasound (OA-CEUS) is a novel technique of ultrasound (US) for gut. Contrast agent made by Chinese yam is taken orally to dilate the lumen of the upper gastrointestinal tract. Thus, the impediment of gas inside gastrointestinal tract is removed and a good acoustic window is provided for gastroin-testinal tract scanning. This paper describes a case of GF secondary to CD detected by OA-CEUS when it was missed by endoscopy and computed tomography (CT). To our knowledge, this is the first report of GF secondary to CD detected by OA-CEUS up to date. CASE SUMMARY: A 29-year-old woman with a 6-year history of CD was admitted to our hospital for abdominal pain and diarrhea for 5 months without obvious predisposing causes. Initial gastroscopy failed to show any evidence of lesions. Colonoscopy revealed multiple erosions, mucosal nodularity, linear ulcers and a cobblestone appearance. A CT scan of her abdomen showed a complex multilocular structure adherent to the greater curvature of the stomach in her left lower abdomen, with fluid, gas and significant surrounding inflammation. CT also demonstrated an abdominal abscess, which was later treated with US-guided drainage. Colonoscopy, gastroscopy and CT missed the presence of a GF. OA-CEUS was performed. A contrast agent made from Chinese yam was taken orally to dilate the lumen of the gastrointestinal tract. A good acoustic window was provided for gastrointestinal tract scanning and the impediment of gas inside the gastrointestinal tract was removed. With the aid of the "window", a canal with hypoechoic wall was identified connecting the greater curvature of stomach to the splenic colon flexure in free sections. We also observed the hyperechoic gas flowing dynamically inside the canal. Thus, a GF was suspected. US is the first imaging modality taking GF into account. At the same time, OA-CEUS identified the site of the fistula and its two orifices. Gastroscopy was performed again, revealing a small ulcer approximately 5 mm in diameter, which was considered as an orifice. On the basis of OA-CEUS and other examinations, the patient was diagnosed with a GF secondary to CD. Then, laparoscopic exploration, partial stomach resection, transverse colostomy and abdominal abscess drainage were performed. The patient recovered uneventfully. CONCLUSION: GFs are rare, occult and potentially life-threatening complications in CD. US is one of the first-line modalities to evaluate CD and its complications. OA-CEUS, a novel technique of US for gut, may be helpful in reducing the possibility of a missed diagnosis of GF.

Surgical Management of a Chronic Sleeve Gastrocolic Fistula with Near Total Gastrectomy and Roux-en-Y Reconstruction.

BACKGROUND: Management of the leak is determined by the duration of the leak from the initial surgery. Acute leaks occurring less than 72 hours after surgery are best managed with reoperation and primary repair. Intermediate leaks, greater than 72 hours but less than 12 weeks, can be managed with non-operative management in non-septic patients. When non-operative management fails beyond 12 weeks the leak is considered a chronic fistula which are best treated with definitive operative management. Sub-total gastrectomy with Roux-En-Y reconstruction with gastrojejunostomy, has been reported with resolution of the fistula in over 90% of cases. OBJECTIVES: To demonstrate the operative management of chronic sleeve gastrectomy leaks. METHODS: A 37-year-old male with a history of a sleeve gastrectomy, developed a chronic fistula between the distal gastric staple line and the transverse colon. After non-operative management failed the patient was taken to the operating room for a diagnostic laparoscopy with plans to perform a revision. A fistula between the distal sleeve staple line and the transverse colon was identified. The gastroesophageal junction was dissected and inspected, there was no fistula at the angle of His. A near total gastrectomy was then performed leaving a small gastric pouch. The colonic side of the fistula was oversewn. Roux-En-Y reconstruction was then performed. RESULTS: No leak identified at four-month follow-up. CONCLUSION: Leak after sleeve gastrectomy can be difficult to manage. Chronic leaks do not respond well to non-operative management. Partial gastrectomy with Roux-En-Y reconstruction is a technically challenging option with good results.

Gastrosplenocolic fistula secondary to non-Hodgkin B-cell lymphoma.

Gastrocolic fistula (GSF) is a rare entity that arises mainly from splenic or gastric lymphoma. Gastric and splenic lymphomas can also fistulate with other organs, including the pleura and the colon, but there has been no reported case to best of our knowledge of a fistula involving three different organs. We hereby present the case of a female patient with gastrosplenocolic fistula secondary to non-Hodgkin B-cell lymphoma. We performed an en bloc partial gastrectomy with splenectomy and partial left colon resection with colostomy. GSF can be treated with chemotherapy. However, when the definite diagnosis is unclear or GSF is causing serious complications such as bleeding or active infection, we believe surgical excision is the treatment of choice.

Giant diverticulum of the transverse colon mimicking gastrocolic fistula: A case report.

INTRODUCTION: Giant transverse colonic diverticula are a rare case of giant colonic diverticulum (GCD). Instead of being asymptomatic, bleeding, inflammation, and perforation may result in fistula formation and require surgery. This type of diverticulum is thought to be closely related to the gastrocolic fistula (GCF). PRESENTATION OF CASE: We report a 26-year-old female presenting severe abdominal pain accompanied by nausea and vomiting and a history of constipation since childhood. The patient felt a mass around the epigastric region and extends to the right hypochondrium. Enema contrast examination showed a large diverticulum in the transverse colon. CT scan revealed a 21.4 × 8.4 cm structure with air-filled structures visible from the transverse colon filled with contrast material, suggesting a possible gastrocolic fistula. Resection was performed on the diverticulum and 20 cm in length of the transverse colon, followed by side-to-side anastomosis. Histopathological findings were type III GCD. The patient was discharged without complications 1 week later. DISCUSSION: Giant diverticulum is characterized by a diverticulum with 4 cm or more in length. Our case was a diverticulum from the central portion of the transverse colon with 25 × 9 × 3 cm in length and type III GCD. Resection was performed on the diverticulum and 20 cm in length of the transverse colon, followed by side-to-side anastomosis. CONCLUSION: Differentiating GCD and GCF with similar clinical course may necessitate multiple investigation before establishing the correct diagnosis. We suggest colectomy followed by side-to-side anastomosis is the best option of treatment for GCD.

Gastrocolic fistula after laparoscopic sleeve gastrectomy: Case report and literature review.

INTRODUCTION: Laparoscopic sleeve gastrectomy is a popular bariatric procedure. Leakage after sleeve gastrectomy is the cornerstone for most of its related morbidity and mortality. Gastrocolic fistula is a rare complication resulting from chronic leak after laparoscopic sleeve gastrectomy. CASE PRESENTATION: We report a case of 32-year-old male who underwent laparoscopic re-sleeve gastrectomy for weight regain after initial uneventful laparoscopic sleeve gastrectomy 3 years back. He presented to emergency department by septic shock secondary to leakage after sleeve gastrectomy. CT abdomen with IV contrast and oral gastrograffin confirmed post sleeve gastrectomy leak. Emergency diagnostic laparoscopy revealed a huge abscess cavity containing pus and dark fecal material and altered blood. A long leak was identified with eversion of gastric mucosa. Tubular structure connecting the upper part of the stomach and the colon was found which turned out to be a gastrocolic fistula. It was controlled by endoscopic linear stapler. After 6 weeks, a definitive open esophago-jeujonostomy with total gastrectomy was done successfully after difficult attempt of laparoscopic intervention. The patient was discharged home in a stable condition. CONCLUSION: A high index of suspicion is important in detection of rare complications after laparoscopic sleeve gastrectomy including gastrocolic fistula. Complete laparoscopic resection of gastrocolic fistula is preferred. Gastrectomy might be the definitive surgery.

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.