Gastrointestinal: Sigmoidocecal fistula diagnosed with colonoscopy

Abstract

Gastrointestinal: Sigmoidocecal fistula diagnosed with colonoscopyA 42-year-old woman underwent a colonoscopy for evaluation of abdominal bloating of three months' duration. Colonoscopic view revealed a large collapsed fistulous opening of the sigmoid colon. The ileocecal valve was identified when the colonoscope was passed through the fistulous opening connecting with the sigmoid colon. When the colonoscope reached the cecum through the conventional intra-luminal technique, white numbers corresponding to the colonoscope insertion length markings could be seen through the fistulous opening (Fig. 1). The appendiceal orifice opening was normal. To confirm the fistulous opening, indigocarmine dye was sprayed into the cecum. The blue dye was found in the sigmoid colon confirming the fistulous connection (Fig. 2). Double contrast barium enema and abdominal computed tomography (CT) scan were also performed. The barium enema also demonstrated the fistulous opening with contrast connecting the mid sigmoid colon and the cecum. Abdominal CT scan also demonstrated an air-filled fistulous tract that extended from the mid sigmoid colon to the cecal pole. However, there were no pericolic inflammation, mesenteric infiltration or bowel wall thickening around the lesion.Colocolonic fistulas are usually a complication of an inflammatory or neoplastic process. However, she had no prior history of any of the predisposing factors related to colocolonic fistulas. A thorough search of English literatures revealed only two cases of sigmoidocecal fistula due to sigmoid diverticulitis or granulomatous colitis. A radiologic study with contrast media is usually used to diagnose intra-abdominal fistulas. In addition, the primary role of colonoscopy may directly visualize the lesion that caused the fistula, and if needed, confirm through histopathologic review. In this case, chromoendoscopy was utilized to prove the presence of the sigmoidocecal fistula during the colonoscopy. Contributed by

Diğer sindirim borusu bölümlerine fistül oluşturan Kolonik kanserler. Olgu serisi ve literatür derlemesi.

“…It has also been suggested that duodenal bile salts have an irritating effects on colonic mucosa resulting in diarrhea. However, colo-colonic fistulas usually have insidious presentation with nonspecific symptoms [7]. Diarrhea and rectal bleeding were the most common symptoms seen in our patients.…”

“…It has been shown that colo-colonic fistulas are usually a complication of inflammatory or neoplastic process. Sigmoido-cecal fistula, most probably as a complication of sigmoid diverticulitis, has been reported in a few case reports [7]. There was only one paper showing ceco-sigmoidal fistula caused by adenocarcinoma of the cecum [8].…”

Sigmoido-Cecal Fistula: A Rare Case of Complicated Recurrent Diverticulitis and a Review of the Literature

“…Finally, Hyun et al referred to the diagnostic tools that are helpful in this uncommon complication. They recommended radiologic studies with contrast media, abdominal CT and colonoscopy combined with chromoendoscopy [10]. It is true that all of the aforementioned modalities can be useful in the diagnosis of sigmoido-cecal fistula, depending, however, on the clinical status of the patient and the manifestation of her or his disease.…”

A Case of Colonic Pseudoobstruction Related to Bacterial Overgrowth Due to a Sigmoidocecal Fistula

“…4 In a thorough search of the English literature, only a few cases of sigmoidocecal fistula due to sigmoid diverticulitis or inflammatory bowel disease were found. 5,6 These abnormal bowel communications, including colocolic fistula, gastrocolic fistula, or jejunocolic fistula, may lead to bacterial overgrowth. of lactulose.…”