Duodenocolic fistula diagnosed by endoscopy: a rare complication of colon cancer

Abstract

Duodenocolic fistula (DCF) is a rare complication of colon cancer with only 70 cases reported since its first description in 1862. Owing to its rarity, current knowledge on DCF still relies on single case reports. We present 2 cases of DCF from a hepatic flexure adenocarcinoma demonstrated initially by endoscopy. 2 adult male patients were admitted due to a 2-3-month history of right-upper quadrant pain, vomiting, diarrhoea and a palpable right upper quadrant mass. In both cases, a circumferential, friable mass was noted on upper endoscopy at the second portion of the duodenum, leading to the ascending colon. A similar-looking lesion was also noted on colonoscopy. Biopsies in both cases confirmed colonic adenocarcinoma. Owing to the advanced nature of the disease, en bloc resection was not achieved. Instead, tube jejunostomy and loop ileostomy were created. Both patients were discharged tolerating feeding with improvement in symptoms.

Ileo-Colonic Fistula Due to Diffuse Large B Cell Lymphoma: Unusual Presentation of a Rare Disease

“…Intractable diarrhea was seen with our patient. In literature, it has been hypothesized to be either secondary to small intestine bacterial overgrowth from colonic microbiota; or a phenomenon similar to short bowel syndrome where the fistula allows intestinal contents to empty directly into the colon prematurely [ 15 ]. Unlike most of the reported cases, our patient did not report any weight loss.…”

Rare intestinal fistula caused by primary lymphoma of the gastrointestinal tract

“…In our case, the persistent diarrhea might be a result of colonization of the small intestine with colonic flora from the sigmoid colon. [ 12 ] It is possible that the fistula between the small and large intestine offers a shortcut, causing intestinal content to fail to be well digested and absorbed, similar to short bowel syndrome.…”

“…Enteroscopy permits direct visualization of the mass and contrast of the mucosa of both intestinal segments. [ 12 ] However, compared to other noninvasive imaging examinations, the enteroscope sometimes fails to reach the fistula because of the narrow and inflamed intestinal lumen. Biopsy under enteroscopy often yields a negative result because of deep lymphomatous lesions that increase the risks of bleeding and perforation.…”