Malignant colo-duodenal fistula; case report and review of the literature

Soulsby, Ruth; Leung, Edmund; Williams, Nigel

doi:10.1186/1477-7819-4-86

Cited by 30 publications

(22 citation statements)

References 28 publications

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“…Hershenson documented only one case among 8,100 autopsies [8]. In present days, these fistulae rarely occur because of an earlier discovery and resection of the tumor, therefore only isolated reports appeared [1]. These malignant causes, other than colonic carcinoma, include carcinoma of the gall bladder [9,10] carcinoma of the duodenum [11] and even from metastatic disease of the esophagus [12].…”

Section: Discussionmentioning

confidence: 99%

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Malignant Coloduodenal Fistulas-Review of Literature and Case Report

Majeed

Agarwal

Shilpa

et al. 2011

Indian J Surg Oncol

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Colo-duodenal fistula is an uncommon complication of malignant and inflammatory bowel disease. Presentation varies from upper abdominal pain, feculent vomiting and diarrhea associated with foul eructation's. Occasionally patients presents with gastro-intestinal bleed. The contact of duodenal bile salts with colonic mucosa frequently leads to diarrhea, so also duodenal colonization with colonic pathogens frequently leads to malabsorption and severe foul eructations. The diagnosis is established either by gastrointestinal contrast studies or contrast enhanced C. T. Scan. Gastroduodenoscopy can demonstrate the fistulous communication or direct invasion and it can also be helpful in obtaining a histological diagnosis. Surgical treatment includes Right Radical hemicolectomy combined with Pancreatico duodenectomy in operable patients and Intestinal bypass for inoperable ones.Right Radical hemicolectomy combined with wedge excision of Duodenum is a suitable alternative in select cases. We report an unusual case of locally advanced carcinoma hepatic flexure of colon with direct invasion of duodenum. Extended right radical hemicolectomy with wedge excision of second part of duodenum was done as an alternative to combined radical hemicolectomy with Pancreatico duodenectomy.

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Section: Discussionmentioning

confidence: 99%

“…Colo-duodenal fistula is a rare complication of malignant and inflammatory bowel disease [1]. The principal causes of entero -enteric fistula in order of frequency are Crohn's disease, diverticular disease, colo-rectal malignancy, radiation enteritis, tuberculosis and actinomycosis [2].…”

Section: Introductionmentioning

confidence: 99%

Malignant Coloduodenal Fistulas-Review of Literature and Case Report

Majeed

Agarwal

Shilpa

et al. 2011

Indian J Surg Oncol

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“…Duodenocolic fistulae are an uncommon form of gastrointestinal fistulae and a rare presentation of colonic malignancies around the hepatic flexure [1, 2]. As in this patient, they typically present with feculent vomiting but cannot be clinically distinguished from gastrocolic fistulae.…”

Section: Discussionmentioning

confidence: 99%

“…Enteroenteric fistulae complicate malignancies and benign conditions such as Crohn’s disease, tuberculosis, actinomycosis, radiation enteritis, diverticulitis, and peptic ulcer disease, and they may rarely be iatrogenic [1–4]. Malignant enteroenteric fistulae more commonly occur between the ileum or jejunum and sigmoid colon malignancies [2].…”

Section: Introductionmentioning

confidence: 99%

Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report

et al. 2017

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BackgroundFistulae between the colon and upper gastrointestinal tract are distressing and uncommon complications of malignancies involving this region. We report a case of a middle-aged man with a locally advanced and metastatic distal transverse colon malignancy who presented with a duodenocolic fistula proximal to the primary tumor and underwent palliative surgery.Case presentationA 50-year-old Sri Lankan man presented to our hospital with a history of feculent vomiting of 1 week’s duration preceded by worsening constipation and abdominal fullness of 2 months’ duration. He also complained of anorexia and significant weight loss over the previous month. His physical examination was unremarkable except for his wasted appearance. Flexible sigmoidoscopy done at his local hospital had not revealed any abnormality in the left colon. Gastroduodenoscopy did not reveal fecal matter or any mucosal abnormalities in the stomach or duodenum. An abdominal contrast-enhanced computed tomographic scan showed a mid-to-distal transverse colonic tumor with a duodenocolic fistula proximal to the primary lesion. At laparotomy, he was found to have an unresectable, locally advanced mid transverse colon tumor with diffuse peritoneal and mesenteric deposits and mild ascites. Palliative end ileostomy and gastrojejunostomy were performed before closure. Histology from the malignant deposits revealed a well-differentiated adenocarcinoma. He made an uneventful recovery with good symptomatic relief.ConclusionsMalignant gastric or duodenocolic fistulae are uncommon complications of locally advanced colonic malignancies with direct invasion to the stomach or duodenum. Although the characteristic clinical presentation of feculent vomiting suggests the diagnosis, cross-sectional imaging is confirmative in addition to staging the disease. Management is guided by disease stage, nutritional status, and the general condition of the patient and ranges from extensive bowel resection including the fistula to palliative options.

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“…Fistulation between the dudodenum and sigmoid has also occurred following oral ingestion of a metallic wire [3] . Colo-duodenal fistulae, although still rare, is more common, with several cases reported in the published literature [4] . They are often associated with colonic malignancy located in the hepatic-flexure and hence lie in close proximity to the duodenum.…”

Section: Discussionmentioning

confidence: 99%