Current Diagnosis and Management of Gastrojejunocolic Fistula

Abstract

We herein report the case of a 51-year-old man with gastrojejunocolic fistula. It is one of the late severe complications of gastrectomy and gastrojejunostomy and is considered to be induced by a stomal ulcer due to inadequate resection of the stomach and incompleteness of vagotomy. The main clinical presentation of this condition is chronic abdominal pain, weight loss, diarrhea, gastrointestinal bleeding and fecal vomiting. The diagnostic workup should include barium enema, gastroscopy and sometimes colonoscopy and abdominal tomography for excluding and ruling out the possibility of malignant extraluminal disease. The historical approach of the treatment of this rare entity was 2-3-phased operations which included colostomy. However today, medical management has recently been recommended as the first-line therapy, with parenteral and enteral support treatments. The preferred surgical approach is single-stage gastrocolic resection and anastomosis and this has been favored to minimize mortality.

Fig. 1

Upper gastrointestinal series assessment confirmed the passage between the corpus of the stomach and the proximal jejunum.

Fig. 2

Tomography showed liquidated small intestine with edema and liquid between the intestine loops.

Fig. 3

At surgery, a retrocolic gastroenterostomy, gastrojejunocolic fistula and incomplete vagotomy were identified.