Gastrocolic fistulas: the increasing role of aspirin.

Abstract

Eight patients had gastrocolic fistulas depicted on barium studies at the authors' hospital during a 10-year period between 1982 and 1992. Seven of those patients (88%) had benign disease, including aspirin-induced gastric ulcers of the greater curvature (n = 4), granulomatous colitis (n = 1), tuberculosis (n = 1), and a penetrating anastomotic ulcer after partial gastrectomy (n = 1). The remaining patient had a malignant gastrocolic fistula caused by carcinoma of the transverse colon. Two patients (25%) experienced classic symptoms of gastrocolic fistulas (ie, feculent vomiting or foul-smelling eructations), but the other six (75%) experienced abdominal pain or other nonspecific clinical findings. In the four patients who were taking aspirin, upper gastrointestinal examinations revealed giant penetrating ulcers of the greater curvature that communicated with the superior border of the transverse colon via a fistula. Three of these patients exhibited marked clinical improvement after conservative medical treatment and did not need surgery. This experience suggests that aspirin-induced gastric ulcers of the greater curvature have become a more common cause of gastrocolic fistulas than is carcinoma of the stomach or transverse colon.

Gastrocolic Fistula: A Rare Complication of Carcinoma Stomach: A Case Report

“…Earlier, adenocarcinoma of the colon and stomach were reported to be the most common cause of gastrocolic fistula [3]. The wide spread use of non-steroidal anti-inflammatory drugs and aspirin accounts for benign gastric ulcer , being the most common cause of gastrocolic fistula formation in the last decade [4,5]. A variety of other causes of gastrocolic fistula have been reported, these include syphilis, tuberculosis, abdominal trauma, crohn's disease, cytomegalovirus gastric infection in AIDS patient and percutaneous endoscopic gastrostomy (PEG) tubes [2,[6][7][8].…”

Fístula gastrocólica na síndrome de Bartter em uso de indometacina: relato de dois casos

“…Nas primeiras séries publicadas, a maioria das fístulas gastrocólicas estava associada ao carcinoma gástrico invadindo o cólon transverso ou ao carcinoma de cólon transverso invadindo a grande curvatura do estômago (1)(2)(3)(4)(5)(6) .…”

“…Key words: Bartters syndrome; Gastrocolic fistula; Indometacin; Barium meal. Fístula gastrocólica na síndrome de Bartter em uso de indometacina: relato de dois casos Atualmente, a maioria das fístulas gastrocólicas está relacionada a doença benigna, em 88% dos casos segundo Levine et al Cinqüenta por cento a 75% das fístulas gastrocólicas estão associados a úlceras gástricas benignas secundárias ao uso de antiinflamatório não-hormonal (1,3) .…”

Diseases of the Upper GI Tract

“…Occasionally, however, benign ulcers may occur on the greater curvature of the distal antrum, and nearly all of these ulcers are found to be caused by NSAIDs [16]. As NSAIDinduced greater curvature ulcers enlarge, they can penetrate inferiorly via the gastrocolic ligament into the transverse colon, producing a gastrocolic fistula [17]. In today's pilloriented society, these NSAID-induced ulcers are the most common cause of gastrocolic fistulas.…”