Introduction: Gastrocolic fistula (GCF) is a rarely reported complication of numerous diseases. When associated with malignancies, the prognosis is usually poor. The classic presentation includes diarrhea, feculent vomiting, and weight loss. Presentation of Case: We hereby report the case of a patient who presented with weight loss and dyspepsia for 2 months, in the absence of diarrhea. Diagnosis of a GCF was made by performing a gastroscopy and a computed tomography scan. The biopsy taken during gastroscopy showed a lower tract gastrointestinal cancer, and the patient underwent surgical treatment by "en bloc" resection. After an anastomosis leak, he recovered well and underwent adjuvant chemotherapy. After a 3-year follow-up, the patient is alive and disease free. Discussion: This case presentation, together with a literature review, underlines that variable symptoms and signs that can be associated to this rare condition. The role of new imaging techniques such as computed tomography scan, compared with barium enema, should also be evaluated in this setting. The absence of lymph-node involvement may predict a good prognosis. Conclusion: GCF is a rare presentation of malignant diseases. In order to diagnose this rare condition a high grade of suspicion is needed, as symptoms are variable and most diagnostic tools are not sensitive enough to recognize it.