When a colonoscopy becomes a duodenoscopy: a palliative treatment of a malignant sigmoidoduodenal fistula

Abstract

We report a case of a 63-year-old female patient suffering from cachexy, anaemia and intractable chronic diarrhoea. As an underlying disease, we found a malignant sigmoidoduodenal fistula of a primary adenocarcinoma of the sigma which represents a rare complication of a frequent disease. Despite the theoretical need for a pancreaticoduodenectomy, only a multivisceral en-bloc resection of the small intestine and left adnexa was performed because of bad general and nutritional condition; this case illustrates a successful multimodal treatment with a palliative intention of a locally advanced colon cancer to alleviate clinical symptoms. The further decourse with the fast development of hepatic metastases confirmed this decision.

Figure 1

The patient's colonoscopy, view from the sigmoid colon (triangles): view into the two branches of the duodenum (stars).

Figure 2

Coronary reconstruction of the patient's abdominal CT scan: the sigmoidoduodenal fistula itself is indicated by a red line, the fistula is indicated with two red arrows and the sigma marked with a green line (reprinted with kind permission of the Department of Radiology at the University Hospital of Basel).