Malignant colo-duodenal fistula: management based on proposed classification

Abstract

Duodenal involvement in colonic malignancy is a rare event and poses challenge to surgeons as it may entail major resection in a malnourished patient. Nine patients with malignant colo-duodenal fistula were reviewed retrospectively. Depending on the pattern of duodenal involvement, it was classified as-type I involving lateral duodenal wall less than half circumference; type II involving more than half circumference away from papilla; type III involving more than half circumference close to papilla. Type I was managed with sleeve resection, type II with segmental and type III with pancreaticoduodenectomy. Median age was 47 years, with male to female ratio of 2:1. Eight patients had anemia and seven had hypoproteinemia. Tumor was located in right colon in eight patients and distal transverse colon in one. Diagnosis of fistula was established by CT abdomen in seven (78%), foregut endoscopy in three and intraoperatively in two patients. Two patients had metastatic disease. Elective resection was done in seven while two required emergence surgery. Five patients underwent sleeve resection of the duodenum, two underwent segmental resection and two required pancreaticoduodenectomy. All patients had negative resection margin. One patient died. Median survival was 14 months in eight survivors. Duodenal resection in malignant colo-duodenal fistula should be tailored based on the extent and pattern of duodenal involvement. Negative margin can be achieved even with sleeve resection. En bloc pancreaticoduodenectomy is sometimes required due to extensive involvement. Resection with negative margin can achieve good survival.

Research and analysis on computed tomography signs and clinical characteristics of chronic duodenal papilla mucositis and duodenal papillary carcinoma

“…Duodenal papilla lesions are common in inflammation, calculus and tumors, of which benign tumors are more common in adenomas, malignant tumors are more common in adenocarcinomas, and others such as lymphomas and stromal tumors are rare. 8 Due to the small size of duodenal papilla malignant tumor in the early stage, CT findings, clinical features and even endoscopic findings are often similar to chronic inflammation of duodenal papilla mucosa, which is easy to be confused. Therefore, it is difficult to diagnose accurately at an early stage.…”

Pancreas-preserving limited duodenal resection: Minimizing morbidity without compromising oncological adequacy

“…Limited duodenal resection for colon carcinoma with direct infiltration or malignant colo-duodenal fistula has been extensively described in literature with good outcome and equivalent survival as compared to more radical resections such as pancreaticoduodenectomy along with colonic resection [ 13 - 16 ]. In a series by Gupta et al [ 17 ], five out of nine patients with malignant colo-duodenal fistula underwent sleeve resection of duodenum with R0 resection status and good outcome. However, the data related to gall bladder cancer with duodenal involvement is limited.…”

Coloduodenal Fistula in Right Colorectal Cancer: Case Report and Review of the Literature

“…Those complications range from medical issues as heart failure from postoperative complication as duodenal or pancreatic leak, intraabdominal abscess leading to septic shock, and eventually death. (1,2,4) Authors agree on the need for pancreaticduodenectomy if absence of distant metastasis is confirmed, there is a real possibility of achieving tumor free margins and the patient status merits an aggressive and oncological procedure. (1,2,4,5).…”

“…(1,2,4) Authors agree on the need for pancreaticduodenectomy if absence of distant metastasis is confirmed, there is a real possibility of achieving tumor free margins and the patient status merits an aggressive and oncological procedure. (1,2,4,5).…”