Outcomes in the management of gastrocolic fistulas: a single surgical unit's experience

Abstract

Background/aims: Gastrocolic fistula has been associated with a variety of diseases. Causative factors are most commonly gastric/colonic cancers and benign gastric ulcers. Treatment modalities may change according to etiology.

Methods: In this study, we present our cases with gastrocolic fistula and the treatment modalities utilized for this uncommon complication. The records of the patients with gastrocolic fistula between November 1996 and June 2006 were retrospectively analyzed.

Results: Six patients with a mean age of 57.5 were determined. Of these, four had malignancy and two had gastric ulcer. The predominant symptoms were diarrhea and vomiting, weight loss, and abdominal pain. Diagnostic studies included barium enema, endoscopy, barium meal, colonoscopy, and computed tomography. After preoperative nutritional support, en-bloc resection of the involved gastrocolic region (4), simple excision (1), and wedge resection of the gastric part and closure of the colonic wall (1) were performed. One patient died of respiratory disorders and there was only one recurrence. In our series, therapeutic management for this unusual disorder included various resection procedures such as simple excision, which may result in recurrence, and wedge resection or en-bloc resection for benign cases, whereas en-bloc resection and reconstruction procedures remained the most applied management for malignant cases. En-bloc resection followed by combination of adjuvant chemotherapy results in long disease-free survival.

Conclusion: Gastrocolic fistula should be suspected in patients with chronic diarrhea and vomiting of unknown cause with a high suspicion of gastrointestinal malignancy.