A Plan for the Surgical Management of Gastrojejunocolic Fistula

Marshall, Samuel F.

doi:10.1097/00000658-194505000-00006

Cited by 16 publications

(9 citation statements)

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“…Due to severe diarrhea, vomiting, less intensive care absences of H2-blockers and proton pump inhibitors mortality and morbidity of patients with GJCF fistula in the late 1930s was very high. Hence, a two-stage or three-stage procedure was recommended to manage cases [5] , [6] , [7] , [8] . This trend of high mortality rate of patients however; was decreased due to the recent advances in parenteral nutritional support and intensive care.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, due to the treatment of peptic ulcers with H 2 receptor antagonists, proton pump inhibitors and eradication of Helicobacter pylori, the incidence of such fistulas has been recently decreased dramatically [10] , [11] . However, since the fistula can develop one to 20 years after gastrectomy [5] , it is still an important and the contribution of previous surgery should not be overlooked. Factors, such as smoking, use of non steroidal anti inflammatory agents, alcohol use and chronic anticoagulation can also lead to postoperative marginal ulceration which in turn lead to GJCF [12] , [13] , [14] .…”

Section: Discussionmentioning

confidence: 99%

“…Marshall and Knud-Hansen and Chung et al. have described the triad of symptoms associated with a GJC fistula as diarrhea, weight loss, and eructation of fecal-smelling gas [3] , [5] . These symptoms were also seen in our cases where both had vomiting of fecal-matter, diarrhea, weight loss and poor appetite.…”

Section: Discussionmentioning

confidence: 99%

“…In the late 1930s, since patients with GJCF fistula were usually malnourished, operative mortality and morbidity were high; as a result, a two-stage or three-stage procedure was recommended [5] .…”

Section: Introductionmentioning

confidence: 99%

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Gastrojejunocolic fistula after gastrojejunostomy in Ayder referral hospital Northern Ethiopia: A report of two cases

Araaya

Desta

Gebremeskel

et al. 2015

Annals of Medicine &Amp; Surgery

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BackgroundGastrojejunocolic fistula (GJCF) is a late and severe complication of a stomal ulcer after gastrojejunostomy, which develops as a result of inadequate resection of stomach or incomplete vagotomy. The occurrence of perforation in a GJCF is even more a rare complication because long evolution time or latent period is required for its appearance. Patients with this condition usually present with diarrhea, weight loss, feculent vomiting, under-nutrition and features of peritonitis that require immediate surgical intervention.Case presentationWe described two cases of gastrojejunocolic fistula in men aged 60 and 40, first cases of gastrojejunocolic fistula seen in our referral hospital and in the whole region following more than a decade after gastrojejunostomy. Both patients initially presented with watery diarrhea, vomiting of fecal materials, poor appetite and weight loss. Upper GI series or barium enema studies allowed a conclusive diagnosis to be made. Both patients underwent one-stage en bloc resection, and their postoperative course and outcome was one cure and one death.ConclusionAs it is rare phenomenon, high clinical suspicion is very important in the diagnosis of GJCF on patients who manifest with chronic diarrhea, vomiting of fecal matter, abdominal pain and features of malnutrition. Careful preoperative preparation is mandatory before any type of surgical procedure is carried out. Pre-operative nutritional status should be evaluated in patients undergoing corrective surgery. Adequate resection of the stomach after Gastrojejunostomy and complete vagotomy is important to prevention development of GJCF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Gastrojejunocolic fistula after gastrojejunostomy in Ayder referral hospital Northern Ethiopia: A report of two cases

Araaya

Desta

Gebremeskel

et al. 2015

Annals of Medicine &Amp; Surgery

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“…Gastrojejunocolic (GJC) fistula is a rare condition after gastrojejunostomy. It was thought to be a late complication related to stomal ulcers as a result of inadequate gastrectomy or incomplete vagotomy [ 1 - 3 ]. In the late 1930s, since patients with GJC fistula were usually malnourished, operative mortality and morbidity were high.…”

Section: Introductionmentioning

confidence: 99%

One-stage laparoscopic-assisted resection of gastrojejunocolic fistula after gastrojejunostomy for duodenal ulcer: a case report

Takemura¹,

Hamano²,

Nishioka³

et al. 2011

J Med Case Reports

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IntroductionGastrojejunocolic fistula is a rare condition after gastrojejunostomy. It was thought to be a late complication related to stomal ulcers as a result of inadequate gastrectomy or incomplete vagotomy. We report a case of gastrojejunocolic fistula after gastrojejunostomy for peptic ulcer treated with one-stage laparoscopic resection.Case presentationA 41-year-old Japanese man complained of diarrhea for 10 months, as well as severe weight loss and weakness. After admission, we immediately started intravenous hyperalimentation. On performing colonoscopy and barium swallow, gastrojejunocolic fistula was observed close to the gastrojejunostomy site leading to the transverse colon. After our patient's nutritional status had improved, one-stage surgical intervention was performed laparoscopically. After the operation, our patient recovered uneventfully and his body weight increased by 5 kg within three months.ConclusionsModern management of gastrojejunocolic fistula is a one-stage resection because of the possibility of early recovery from malnutrition using parenteral nutritional methods. Today, laparoscopic one-stage en bloc resection may be feasible for patients with gastrojejunocolic fistula due to the development of laparoscopic instruments and procedures. We describe the first case of gastrojejunocolic fistula treated laparoscopically by one-stage resection and review the literature.

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