Silent complication: chronic diarrhea as a clue to gastrojejunocolic fistula: A case report

Abstract

Rationale: Gastrocolic fistulae represent abnormal connections between the stomach and large intestine, often leading to chronic diarrhea and malnutrition. They can arise postoperatively, particularly after complex surgeries such as the Billroth II procedure.

Patient concerns: This case report describes the case of a 71-year-old male, with a history of hypertension and gastrointestinal surgery, who experienced significant weight loss and postprandial diarrhea. Initial investigations, including stool cultures and multiple imaging studies, failed to reveal the fistula.

Diagnoses: A definitive diagnosis of gastrojejunocolic fistulae was made during the third gastroscopy, when the endoscope passed from the stomach into the colon.

Interventions: Surgical intervention involved adhesiolysis and resection of the fistula, followed by reconstruction of gastrointestinal continuity.

Outcomes: Postoperative care included nutritional support, and the patient showed a significant improvement at follow-up.

Lessons: This case highlights the diagnostic challenges associated with gastrojejunocolic fistulae and emphasizes the need for a high index of suspicion in patients with atypical gastrointestinal symptoms after complex surgery. This illustrates that timely surgical intervention can lead to positive outcomes, and underscores the importance of ongoing research and education regarding the management of such complications. Further studies are needed to understand the long-term effects of gastrojejunocolic fistulae and optimize management strategies.

Keywords: Billroth II procedure; chronic diarrhea; gastrojejunocolic fistula.

Figure 1.

To the left: Gastroscopy revealing the gastrojejunostomy (downward pointing arrow) and gastric-colonic fistula with fluid and fecal material in the stomach (upward-pointing arrow). To the right: Gastroscopy showing a large gastrocolic fistula with easy endoscopic passage into the colon.

Figure 2.

Barium swallow: transit of barium contrast from the stomach (blue arrow) to the jejunum (yellow arrow) and transverse colon (red arrow) simultaneously indicating the GCF. GCF = gastrocolic fistula.

Figure 3.

Intraoperative findings: presence of communication between the gastrojejunostomy and transverse colon indicating the GCF. GCF = gastrocolic fistula.

Figure 4.

Intraoperative findings: gastrojejunocolic fistula documented by spontaneous passage of nasogastric tube from stomach into jejunum (white circle; left picture) and NGT passage from stomach into the colon (black circle; right picture). C = colon, J = jejunum, S = stomach.

Figure 5.

Intraoperative findings: To the left is the complex fistula before en bloc resection is completed. Right: En bloc resection of the gastrojejunostomy fistula with a specimen on the draped table. C = proximal and distal transverse colon ends, J = jejunum, NGT = nasogastric tube, S = stomach.